Clinical establishment act

Govemment of India

Ministry of Health & Family Welfare Department of Health & Family Welfare

“ut”gJ.ies Regulation) Act,20l0.

.*,

560-4, Nirman Bhawan. New Del

*i,f,i”‘+: days from the date of issue ofthis notice’

i2,

ili’iuv

H””1’r’ *d

oAiuillu;rf.t,iii;;fiS, “;;:iio0ll or by email to hilo.ceact20l0@nic.in 9r lTil1,y”lfl:;l’gi,):;

Joint Secretary

Medical Services Section

NOTICE

Nirman Bhawan’ New Delhi Dated 171h JulY’ 2019

Subiect: Placing the Draft notification on Clinical Establishments (Central “”**” H;;;?.n””t) rhito ‘A’;enament nutes’ 2019 prescribing ‘minimum-

of. clinical establishments of

for comments/suggestion-

standards fo’ Oif”‘”oi

;ffi;iil ano AYUSH’ in p’frlic domain

regarding

“ut”gories

Mot{FW plans to notil, the rules to prescribe for “minimum standards

of cliniJal .stuutirtrments of Atlopathy-and AYUSH ‘,

oi,tt”-Ctini”ut Establishm;nts (Registration and The comments/suggestions on the draft maY be forward.ed t: ?1tll’

DRAFT

fIo be published in the Gazette ol lndia’ Extraordinary Part ll’ Section 3′ Sub- section (i)l

Government of lndia

Ministry of Health and Family Wellare (Department of Health and Family Welfare)

New Delhi, the l? JulY, 2019.

Notification

G.S.R.-(E). -The following draft of certain rules lurther to amend the

ClinicalEstablishments(CentralGovernment)Rules,20l2,whichthecentral Government proposes to make in exercise of the powers conferred by section 52 of

theclinicalEstablishments(RegistrationandRegulation)Act,2o1o(23oI2010)iS hereby published for information of all persons likely to be affected thereby and

notice is hereby given that the said draft rules will be taken into consideration on or after the expiry of a period of forty five days from the date on which copies of the Gazette of lndia containing these draft rules are made available to the public;

Obiections and suggestions’ if any’ may be addressed to Dr’ Anil Kumar’

Addl.DDG,Dte.GHS,MinistryofHealthandfamilyWelfare’RoomNo560-A Nirman Bhawan, New Delhi- 110011 or sent on email to help ceact2o’1o@nic’in;

Objections and suggestions which may be received from any person within the period specitied above will be considered by the Central Government’

(1) These rules may be called the Clinical Establishments (Central

Government) Third Amendment Rules’ 2019′

(2) They shall come into lorce on the date of their pubtication in the olficial Gazette.

In the said rules, after rule 8′ the following rules shall be inserted’ namely:

SBMinimumstandardsofHindiandEnglishversionsofapprovedminimum 3?;oiliii’ii, iljr,”-‘iini catesories of nttopathic clinicar Estabrishments

Minimum Standards (General) of Clinical establishments as listed under:

1. clinic or Polyclinic: only Consultation, With Dispensary, With Diagnostic Support and With Observation facility

2. Mobile Clinic: Only Consultation’ With Procedures and Dental Mobile

3. Hospitals: Level 1 to 3 4. Health Check-uP Centre

5. Dental Lab

6. PhysiotheraPY

7. Dietetics

8. lntegrated Counselling Centre

MinimumstandardsofSpecilicspecialityisuperspecialityclinicaldepartments/ establishments

1 Anaesthesiology

2. a. Paediatrics (Hospital) b Paediatrics (Clinic)

3. Burn Care Facility (HosPital)

4. a. Plastic Surgery (Hospital) b’ Plastic Surgery (Clinic) 5. a. Cardiology (Hospital) b Cardiology Services (Clinic)

6. DentalSet up a’ Stand Alone b Hospital SetUp

7. a. Dermatology (Hospital) b Dermatology (Clinic) c’ STD Clinic

8. a. Gastroenterology (Hospital) b’ Gastroenterology (Clinic) 9. a. General Surgery (Hospital) b’ General Surgery(Clinic)

’10. a. Neurology (Hospital) b Neurology (clinic)

11. a. Neurosurgery (Hospital) b Neurosurgery (Clinic)

l2.a.GynaeandObstetricslndoorservices(Hospital)b’Gynaeand Jo”*r,””ic,,n'”) ” lVF centre /ctinic (lcMR Norm)

13. a. Orthopaedic (Hospital) b Orthopaedic Services (Clinic)

14,a.otorhinolaryngology(Hospital)b,otorhinolaryngology(clinic)c,Deaf and Dumb Clinic

15. a. Psychiatry SeNices (Hospital) b Psychiatry Services (Clinic) c’

Deaddiction Centre

16. a. Ophthalmology (Hospital) b’ Ophthalmology (Clinic) c Optometrist

Services

17. a. Urology (Hospital) b Urology Services (Clinic)

’18. Dialysis Centre – merged with Nephrology 19. a. CTVS (Hospital) b CTVS (clinic)

20. Radiotherapy

21. Medical Diagnostic Laboratories

22. a. lmaging Centers – X-Ray clinic / Cathlab / DSA / OPG and Dental / DE)(A Scan

b. lmaging centers – Sonography (color Doppler) clinic c. lmaging Centers – CT Scan Center / PET CT Scan

d. lmaging Centers – MRI

23. a. Rheumatology b Rheumatology Clinic /Polyclinic

24. a. Pulmonology b Pulmonology clinic

25. a. Medical Oncology /Clinical Haematology b Medical Oncology /Clinical HaematologY Clinic /PolYclinic

26. a. Gynae Oncology b Gynae Oncology clinid Polyclinic 27. a. Surgical Oncology b Surgical Oncology Clinic /Polyclinic

28. a. Neonatology Clinic b’ Neonatology

29. a. Paediatric Surgery b Paediatric Surgery Clinic Polyclinic

30. Palliative Care

31. Gl Surgery a. Hospital b’ Clinic

32. Endocrinology a Hospital b’ Clinic

33. PMR clinic

34. Nephrology a. Hospital b’ Clinic

35. Medicine and geriatrics a Hospital b Clinic’

‘

Note:

B,llxH:,flil11i:fi ^J!,:I $l’J’illlil’;ff t”‘l#’Xffi:i’ :ill?gi Establishments

I F. No. A.12034/18/201g-MH-IVMS]

Dr. Mandeep K Bhandari’ Joint Secretary The principal rules were published in the Gazette oI lndia’ Extraordinary’ Part

3, sub-section (i) vide notification number May,2112and last vide notiflcation number G S R 468(E)’

2014.

ll, Section

dated the 18th May’

G S’R 387(E)’ dated the 23rd

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

Clinical Establishments Act Standard for

Clinic or Polyclinic (Only Consultation)

Standard No. CEA orClinic- 001

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

Table of Contents

Sr. No.

Particulars

Page No.

Definition

Scope

Infrastructure

Furniture & Fixture

Human Resource

EquipmentorInstrumentsorDrugs

Support Service

LegalorStatutory Requirements

Record Maintenance and Reporting

10.

Process

11.

Appendix -1

12.

Appendix -2

13.

Appendix -3

14.

Appendix -4

15.

Appendix -5

16.

Appendix -6

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

Clinic or Polyclinic (Only Consultation)

1. Definition

1.1 A clinic may be defined as a Clinical establishment providing examination, consultation, prescription to outpatients including dispensing of medicines by a single general practitioner or a specialist doctor or a super-specialist doctor.

1.2 A polyclinic may be defined as a Clinical establishment providing examination, consultation, prescription to outpatients including dispensing of medicines by more than one doctor or general practitioners or specialist doctors or super- specialist doctors.

1.3 A few minor procedures like dressing and administering Injectionections etc may be provided in the clinic or polyclinic however not requiring observation or short stay.

2. Scope (as applicable)

2.1 These set of common minimum standards framed are applicable to a single practitioner or more than one doctor clinic manned by a General physician or specialist doctor or super specialist or a group of doctors who are themselves providing patient care services like dispensing of medicines, Injectionection and dressing.

2.2 To provide examination, consultation, prescription to outpatients by a single doctor or general physician or specialist doctors or super-specialist doctor or group of doctors who are themselves providing patient care services like dispensing of medicines, Injectionection and dressing.

2.3 Advice for health education and health promotion;

2.4 Any or more than one of the following are included:

a) General Physician

b) Cardiology

c) Cardiothoracic surgery

d) Dermatology

e) ENT

f) Endocrinology

g) Gastroenterology

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

h) Internal Medicine

i) General Surgery

j) Gastro Intestinal Surgery

k) Gynecology & Obstetrics

l) Medical Oncology

m) Surgical Oncology

n) Nephrology

o) Neurosurgery

p) Neurology

q) Ophthalmology

r) Orthopedics

s) Pediatrics

t) Pediatric Surgery

u) Psychiatry

v) Rheumatology

w) Thoracic surgery

x) Tuberculosis and Respiratory Diseases

y) Urology

3. Infrastructure

3.1 The physical facility shall be developed and maintained to provide safe and secure environment for patients, their families, staff and visitors. It shall be situated in a place having clean surroundings and shall comply with local byelaws in force, if any, from time to time.

3.2 The minimum space requirement for carrying out the basic functions of the facility shall be as per Appendix 1.

3.3 The clinic facility shall be well illuminated, ventilated and clean with adequate water supply.

3.4 The clinic shall have a prominent board or signage displaying the name of the clinic in local language at the gate or on the building of the clinic.

3.5 The following other signage shall be well displayed in the language understood by the local public in the area:

a) Name of the doctor(s) with registration number.

b) Fee structure of the various doctors or specialists.

c) Timings of the clinics (For example: from 8am -2pm)

d) Services provided within the Facility.

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

4. Furniture & Fixtures

4.1 Furniture and fixtures shall be available in accordance with the activities and workload of the Clinic or polyclinic.

4.2 The furniture and fixtures shall be functional all the time. For indicative list of items refer Appendix 2 (this list is indicative and not exhaustive).

5. Human Resource

5.1 The general practitioner or specialist doctor or super-specialist doctors as per the scope of the clinic or polyclinic shall be registered with State or Central Medical Council of India.

5.2 The services provided by the medical professionals shall be in consonance with their qualification, training and registration.

5.3 In a clinic or polyclinic, minimum one support staff must be available to meet the care treatment and service needs of the patient. However number may depend upon the workload and scope of the service being provided by the clinical establishment.

6. Equipmentorinstrumentsordrugs

6.1 The clinic or polyclinic shall have essential equipment as per Appendix3, and emergency equipment as per Appendix 4.

6.2 Other equipment as per the scope of service being practiced shall be available.

6.3 Adequate space for storage of equipment and medicines shall be provided and if available medicines shall be stored as per manufacturer’s guidelines. The equipment shall be of adequate capacity to meet work load requirement.

6.4 All equipment shall be in good working condition at all times. Periodic inspection, cleaning, maintenance of equipment shall be done.

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

6.5

7.1

The clinic or polyclinic shall have basic minimal essential drugs as per Appendix 5; however other drugs as per the scope of service being practiced may also be available.

Support Service

In a clinic or polyclinic minimum one support staff must be available to meet the care treatment and service needs of the patient. However number may depend upon the workload and scope of the service being provided by the clinical establishment.

Legal or Statutory Requirements

Name of the Act or License

Licensing body

Registration of medical doctor with CentralorState Medical Council

MCI or State Medical Council as applicable

Biomedical Waste Management Rules, 2016

State Pollution Control Board

Registration of the Clinic

State Council

9.1

9.2

Record Maintenance and reporting

Every Clinical Establishment shall maintain medical records of patients treated by it and health information and statistics in respect of national programmes and furnish the same to the district authorities in form of quarterly reports.

All clinical establishments shall be responsible for submission of information and statistics in time of emergency or disaster or epidemic situation or as required from time to time by National Council, Clinical eEtablishments Act 2010.

10. Process

10.1 Registration

10.1.1 Every patient visiting the clinic shall be registered.

10.1.2Patient shall be guided and informed regarding Patients’ Rights and

Responsibilities Appendix 6

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

10.2 Assessment

10.2.1Every patient shall undergo assessment, during the course of assessment, the patient findings, medications and investigations should be documented with working diagnosis, legibly in the assessment or OPD prescription with the signature of the consultant or Specialist or Super specialist with date and time.

10.3 Infection Control

10.3.1 The clinic shall take all precautions to control infections like practising hand hygiene etc.

10.3.2 Availability of clean water for hand washing or liberal use of sanitizer shall be maintained throughout the working hours of the clinic.

10.3.3 Sanitation and hygiene of the toilets if available shall be maintained.

10.3.4 Mopping of all patient care areas with disinfectant shall be done at least once a day.

10.4 Safety Considerations

10.4.1 The clinic shall ensure to take care of patient safety aspects like patient fall, etc.

10.4.2 The clinic shall be kept pest and termite free.

10.5.1 Biomedical waste shall be managed in accordance with the Bio Medical Waste management Rules, 2016.

10.5.2 Clinic waste generated shall be segregated at source.

10.5.3 Needles and sharp waste shall be stored in tamper proof, leak proof and puncture proof container.

10.6 First aid

10.6.1 Provision shall be made for providing First Aid.

10.6.2 Contact details of ambulance hospital etc shall be available in case of emergency.

10.5

Biomedical waste Management

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

APPENDIX 1

Infrastructure Requirement (Desirable)

Minimum area required for clinic shall be as follows:

LOCATION

AREA REQUIRED

REMARKS

Common area (Reception and waiting)

35 sq ft carpet area

Consultation room (ancillary area)

70 sq ft including storage

Area specified under consultation room is only for single clinic and shall be multiplied accordingly by the number of consultation chambers.

Note: Reception, waiting, consultation room etc shall be adequate as per the requirement and workload of the clinic.

Ancillary areaorspace: Storage of records, reagents, consumables, stationery etc and eating area for staff.

APPENDIX 2

Furniture or fixtures

S.N.

Articles

Table

Chairs

Examination Table or couch

Screens

Foot Step

Stools

Storage Cabinet for records etc.

BMW storage area

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

I. Essential Equipment

APPENDIX 3

Equipment or Instrument

S. No.

Name of the equipment

Minimum Specifications

No. of equipment

Stethoscope

Thermometer

(Non Mercury)

Torch (flash lights)

Sphygmomanometer(Blood Pressure Apparatus)

(Non Mercury)

Weighing machine(Optional)

Adult

APPENDIX 4

I. Emergency Equipment

S. No.

Name of the equipment

Minimum Specifications

No. of equipment

Resuscitation Equipment Ambu Bag or Air Way

– Adult

– Pediatric

1 1

Oxygen Concentrator or Cylinder (Portable)

Fire Extinguisher

–

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

APPENDIX 5

I. Emergency Drugs

S. No.

Name of the Drug

Minimum Quantity

Injection Adrenaline

2 Ampoules

Injection Hydrocortisone

1 vial

Injection Atropine

1 Ampoule

Injection Pheniramine maleate

1 Ampoule

Injection Promethazine

1 Ampoule

Injection Deriyphylline

1 Ampoule

Injection. Frusemide

1 Ampoule

Injection. Metoclopramide

1 Ampoule

Injection Dexamethasone

1 Ampoule

Injection Diazepam

1 Ampoule

Injection Dicyclomine Hydrochloride

1 Ampoule

Injection 5% dextrose infusion

1 Vac

Injection Normal saline

1 Vac

Clinical Establishments Act Standards for Clinic or Poly Clinic (Only Consultation)

CEA /Clinic- 001

APPENDIX 6

Patients’ Rights and Responsibilities: Patients’ Rights

A patient and his or her representative has the following rights with respect to the clinical establishment-

1. To adequate relevant information about the nature, cause of illness, proposed investigations and care, expected results of treatment, possible complications and expected costs;

2. Rate of services provided by the clinical establishment would be displayed prominently.

3. To access a copy of case papers, patient records, investigations reports and detailed bill.

4. To informed consent prior to specific tests or treatment (e.g. surgery, chemotherapy)

5. To seek second opinion from an appropriate clinician of patients’ choice, with records and information being provided by treating hospital

6. To confidentiality, human dignity and privacy during treatment.

7. To have ensured presence of a female person, during physical examination of

a female patient by a male practitioner.

8. To non-discrimination about treatment and behaviour on the basis of HIV

status.

9. To choose alternative treatment if options are available.

10. Rate of services provided by the clinical establishment would be displayed

prominently.

Patients’ Responsibilities

Provide all health related information

Cooperate with Doctors during examination and treatment

Follow all instructions

Pay hospitals agreed fees on time

Respect dignity of doctors and other hospital staff

Never resort to violence

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

Clinical Establishments

Act Standard for

Clinic or Polyclinic

with Dispensary Standard No.CEA/Clinic- 002

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

Table of Contents

Sr. No.

Particulars

Page No.

Definition

Scope (as applicable)

Infrastructure

Furniture and Fixtures

Human Resource

Equipment or Instruments or Drugs

Support Service

Legal or Statutory Requirements

Record Maintenance and Reporting

Process

Appendix -1

Appendix -2

Appendix -3

Appendix -4

Appendix -5

Appendix -6

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

Clinicor Polyclinic with Dispensary

11. Definition

11.1 A clinic may be defined as a clinical establishment providing examination, consultation, prescription to outpatients including dispensing of medicines by a single or general practitioner or group of general practitioners or specialist doctor or super-specialist doctor.

11.2 A polyclinic may be defined as a clinical establishment providing examination, consultation, prescription to outpatients including dispensing of medicines by more than one doctor or general practitioner or group of general practitioners or specialist doctor or super-specialist doctor.

11.3 A few minor procedures like dressing, administering Injections, family planning etc may be provided in the clinic or polyclinic however not requiring observation or short stay.

11.4 Dispensing of medicines shall be done by qualified professionals to out- patients.

12.Scope (as applicable)

12.1 These set of common minimum standards framed are applicable to a single practitioner or more than one doctor clinic manned by a general physician or specialist doctor or super specialist or a group of doctors who are themselves providing patient care services like dispensing of medicines, Injections and dressings.

12.2 To provide examination, consultation, prescription to outpatients by a single doctor or general physician or specialist doctor or super-specialist doctor or group of doctors who are themselves providing patient care services like dispensing of medicines, Injections and dressings.

12.3 To deliver primary service in health education and health promotion;

12.4 To deliver health care services of rehabilitative nature.

12.5 Any or more than one of the following are included:

a) General Physician

b) Cardiology

c) Cardiothoracic surgery

d) Dermatology

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

e) ENT

f) Endocrinology

g) Gastroenterology

h) Internal Medicine

i) General Surgery

j) Gastro Intestinal Surgery

k) Gynecology & Obstetrics

l) Medical Oncology

m) Surgical Oncology

n) Nephrology

o) Neurosurgery

p) Neurology

q) Ophthalmology

r) Orthopedics

s) Pediatrics

t) Pediatric surgery

u) Psychiatry

v) Rheumatology

w) Thoracic surgery

x) Tuberculosis and Respiratory Diseases

y) Urology

13. Infrastructure

13.1 The physical facility shall be developed and maintained to provide safe and secure environment for patients, their families, staff and visitors. It shall be situated in a place having clean surroundings and shall comply with local byelaws in force, if any, from time to time.

13.2 The minimum space requirement for carrying out the basic functions of the facility shall be as per Appendix 1.

13.3 The area shall be well illuminated, ventilated and clean with adequate water supply.

13.4 The clinic shall have a prominent board or signage displaying the name of the clinic in local language at the gate or on the building of the clinic.

13.5 The following other signages shall be well displayed in the language understood by the local public in the area:

a) Name of the doctor(s) with registration number(s).

b) Fee structure of the various doctors or specialists

c) Timings of the clinics (For e.g. from 8am -2pm)

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

d) Services provided within the facility

14.Furniture & Fixtures

14.1 Furniture and fixtures shall be available in accordance with the activities and workload of the Clinic or polyclinic.

14.2 The furniture and fixtures shall be functional all the time. For indicative list of items refer to Appendix 2 (This list is indicative and not exhaustive).

15.Human Resource Requirements

15.1 A single general practitioner or group of general practitioners or specialist doctors or super-specialist doctors as per the scope of the clinic or polyclinic shall be registered with State or Central Medical Council of India.

15.2 The services provided by the medical professionals shall be in consonance with their qualification, training and registration.

15.3 If dispensing is done by paramedic like pharmacist, he shall be qualified, trained and registered with the Pharmacy Council.

16.Equipment or instruments or drugs

16.1 The clinic or polyclinic shall have essential equipments as per Appendix 3 and emergency equipment as per Appendix 4.

16.2 Other equipments as per the scope of service being practised shall also be available.

16.3 Adequate space for storage of equipments and medicines shall be provided and if available medicines shall be stored as per manufacturer’s guidelines. The equipment shall be of adequate capacity to meet work load requirement.

16.4 All equipment shall be in good working condition at all times. Periodic inspection, cleaning, maintenance of equipment shall be done.

16.5 The clinic or polyclinic shall have basic minimal essential drugs as per Appendix 5; however other drugs as per the scope of service being practised may also be available.

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

17.Support Service

7.1 In a Clinic or polyclinic, minimum one support staff must be available to meet the care, treatment and service needs of the patient. However number may depend upon the workload and scope of the service being provided by the clinical establishment.

18.LegalorStatutory Requirements

S. No

Name of the Actor License

Department or Area

Licensing body

Registration of medical doctor with Central or State Medical Council

Administration

MCI or State Medical Council

Biomedical Waste Management Rules, 2016

Administration

State pollution control Board

Local registration of the Clinic

Administration

State Council

Pharmacy License

Administration

Indian Pharmacy Council

19.Record Maintenance and reporting

19.1 Every Clinical Establishment shall maintain medical records of patients treated by it and health information and statistics in respect of national programmes and furnish the same to the district authorities in form of quarterly reports.

19.2 All clinical establishments shall be responsible for submission of information and statistics in time of emergency or disaster or epidemic situation or as required from time to time by National Council, Clinical Establishments Act 2010.

19.3 Medicine Records and Registers

20.Basic processes 10.1 Registration

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

Every patient visiting the clinic shall be registered.

10.1.1Patient shall be guided and informed regarding Patients’ rights and

responsibilities Appendix 6 10.2 Assessment

10.2.1 Every patient shall undergo assessment, during the course of assessment, the patient findings, medications and investigations should be documented with working diagnosis, legibly in the assessment or OPD prescription with the signature of the consultant or Specialist or Super Specialist with date and time.

10.2.2 Medicines shall be dispensed by qualified doctor or pharmacist as allowed by law.

10.2.3 No medicines shall be dispensed from pharmacy store without a written prescription order of doctor, except in emergency cases. Medication dispensing shall be done with care to prevent any medication error. Following shall be checked before dispensing of medication. These checks shall be done at store level.

10.2.3.1 10.2.3.2 10.2.3.3 10.2.3.4 10.2.3.5

Medicine prescribed.

Dose of prescribed medicine.

Expiry date.

Particulate matter in liquid dosage forms and parenteral drugs. Labels (if reconstituted drugs).

10.2.4 Labeling shall be done for every prepared or reconstituted medication, which shall include name, date of preparation, strength and frequency of administration of drug.

10.3 Infection Control

10.3.1 The clinic shall take all precautions to control infections like practising hand hygiene etc.

10.3.2 The clinic shall have availability of clean water for hand washing or should be maintained throughout the working hours of the clinic.

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

10.3.3 Sanitation and hygiene of the toilets if available shall be maintained.

10.3.4 Mopping of all patient care areas with disinfectant shall be done at least once a day

10.4 Safety Considerations

10.4.1 Effort shall be made to take care of patient safety aspects like patient fall, etc.

10.4.2 Effort shall be made to keep clinic pest and termite free.

10.5 Biomedical waste Management

10.5.1 Biomedical waste should be managed in accordance with the BMW management Rules, 2016.

10.5.2 Clinic waste generated should be segregated at source.

10.5.3 Needles and sharp waste should be stored in puncture proof, leak proof and tamper proof containers.

10.6 First aid

10.6 Provision shall be made for providing First Aid.

10.7 Contact details of ambulance hospital etc shall be available.

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

Minimum area required for a clinic:

APPENDIX 1

Infrastructure requirement (Desirable)

LOCATION

AREA REQUIRED

REMARKS

Common area (Reception and waiting)

35 sq ft carpet area

Consultation room (ancillary area)

70 sq ft carpet area including storage

Area specified under consultation room is only for single clinic and shall be multiplied accordingly by the number of consultation chambers.

Store and pharmacy

40 sq ft

Note: Reception, waiting, consultation room etc shall be adequate as per the requirement and workload of the clinic.

Ancillary area or space: Storage of records, reagents, consumables, stationery etc

Furniture or fixtures

APPENDIX 2

S.N.

Articles

Table

Chairs

Examination Table or couch

Screens

Foot Step

Stools

Storage Cabinet for records etc.

BMW Storage area

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

I. Essential Equipment:

APPENDIX- 3

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Stethoscope

Thermometer

(Non Mercury)

Torch (flash lights)

Sphygmomanometer (B.P. Apparatus)

(Non Mercury)

Weighing machine (Optional)

Adult

APPENDIX- 4

I. Emergency Equipment:

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Resuscitation Equipment Ambu Bag or Air Way

– Adult

– Pediatric

1 1

Oxygen Concentrator or Cylinder (Portable)

Fire Extinguisher

–

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

APPENDIX- 5

I. Emergency Drugs

S. No.

Name of the Drug

Minimum Quantity

Injection Adrenaline

2 Ampoules

Injection Hydrocortisone

1 vial

Injection Atropine

1 Ampoule

Injection Pheniramine maleate

1 Ampoule

Injection Promethazine

1 Ampoule

Injection Deriyphylline

1 Ampoule

Injection Frusemide

1 Ampoule

Injection Metoclopramide

1 Ampoule

Injection Dexamethasone

1 Ampoule

Injection. Diazepam

1 Ampoule

Injection Dicyclomine Hydrochloride

1 Ampoule

Injection. 5% dextrose infusion

1 Vac

Injection. Normal saline

1 Vac

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

APPENDIX 6 Patients’ rights and responsibilities:

Patients’ Rights

A patient and his or her representative has the following rights with respect to the clinical establishment-

11. To adequate relevant information about the nature, cause of illness, proposed investigations and care, expected results of treatment, possible complications and expected costs;

12. Rate of services provided by the clinical establishment would be displayed prominently.

13. To access a copy of case papers, patient records, investigations reports and detailed bill.

14. To informed consent prior to specific tests or treatment (e.g. surgery, chemotherapy.)

15. To seek second opinion from an appropriate clinician of patients’ choice, with records and information being provided by treating hospital

16. To confidentiality, human dignity and privacy during treatment.

17. To have ensured presence of a female person, during physical examination of

a female patient by a male practitioner.

18. To non-discrimination about treatment and behaviour on the basis of HIV

status.

19. To choose alternative treatment if options are available

20. Rate of services provided by the clinical establishment would be displayed

prominently.

Patients’ Responsibilities

Provide all health related information

Cooperate with doctors during examination, treatment etc

Follow all instructions

Pay hospitals agreed fees on time

Respect dignity of doctors and other hospital staff

Never resort to violence

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

Clinical Establishments Act Standard for Clinic or Polyclinic or Dispensary with Diagnostic Support Services

Standard No.CEA or Clinic-003

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

Table of Contents

Particulars

Page No.

Definition

Scope (as applicable)

Infrastructure

Furniture & Fixture

Human Resource

Equipment or Instruments or Drugs

Support Service

Legal or Statutory Requirements

Record Maintenance and Reporting

Process

Appendix -1

Appendix -2

Appendix -3

Appendix -4

Appendix -5

Appendix -6

Appendix -7

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

Clinicor Polyclinic with Diagnostic Support Services

11 Definition

11.1 A clinic with support services may be defined as a healthcare facility providing examination, consultation, prescription to outpatients by a single general practitioner or or a group of general practitioners or specialist doctor or super- specialist doctor. In addition, also have the support services like pharmacy, Injections, family planning facility, dressing room, and sample collection facility, basic laboratory, X- ray, USG with or without color Doppler, ECG or any other.

12 Scope (as applicable)

12.1 These set of common minimum standards framed are applicable to a single practitioner or more than one doctor clinic manned by a General physician or specialist doctor or super specialist or a group of doctors who are providing patient care services like dispensing of medicines, Injection and dressing, with observation or short stay facility. In addition, also have the support services like pharmacy, Injections, family planning facility, dressing room, sample collection facility, basic laboratory, X- ray, USG with or without colour Doppler, ECG or any other.

12.2 To provide examination, consultation, prescription to outpatients by a single doctor or general physician or specialist doctors or super-specialist doctor or group of doctors who are providing patient care services like dispensing of medicines, Injection and dressing with observation or short stay facility.

12.3 To deliver primary service in health education and health promotion;

12.4 To deliver health care services of rehabilitative nature.

12.5 Any or more than one of the following are included:

a) General Physician

b) Cardiology

c) Cardiothoracic surgery

d) Dermatology

e) ENT

f) Endocrinology

g) Gastroenterology

It differs from Health checkup center which provides health preventive and promotive services.

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

h) Internal Medicine

i) General Surgery

j) Gastro Intestinal Surgery

k) Gynecology & Obstetrics

l) Medical Oncology

m) Surgical Oncology

n) Nephrology

o) Neurosurgery

p) Neurology

q) Ophthalmology

r) Orthopedics

s) Pediatrics

t) Pediatric surgery

u) Psychiatry

v) Rheumatology

w) Thoracic surgery

x) Tuberculosis and Respiratory Diseases

y) Urology

13 Infrastructure

13.2 The minimum space requirement for carrying out the basic functions of the facility shall be as per Appendix 1.

13.3 The area shall be well illuminated, ventilated and clean with adequate water supply.

13.4 The clinic shall have a prominent board or signage displaying the name of the clinic in local language at the gate or on the building of the clinic.

13.5 The following other signage shall be well displayed in the language understood by the local public in the area:

a) Name of the doctors with registration number.

b) Fee structure of the various doctors or specialists

c) Timings of the clinics (For e.g. – from 8am -2pm)

d) Services provided within the Facility

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

14 Furniture & Fixtures

14.1 Furniture and fixtures shall be available in accordance with the activities and workload of the Clinic or Polyclinic.

14.2 The furniture and fixtures shall be functional all the time. For indicative list of items, refer to Appendix 2. (This list is indicative and not exhaustive).

15 Human Resource

15.1 The general practitioner or specialist doctor or super-specialist doctors as per the scope of the clinic or polyclinic shall be registered with State or Central Medical Council of India.

15.2 The services provided by the medical professionals shall be in consonance with their qualification, training and registration.

15.3 In a polyclinic, minimum one support staff must be available to meet the care treatment and service needs of the patient. However, number may depend upon the workload and scope of the service being provided by the clinical establishment.

16 Equipmentor instrumentsor drugs

16.1 The clinic or polyclinic shall have essential equipment as per Appendix 3, emergency equipment Appendix 4 and other equipment as per the scope of service being practiced as per Appendix 5.

16.2 Adequate space for storage of medicines equipment etc shall be provided. The equipment shall be of adequate capacity to meet work load requirement.

16.3 All equipment shall be in good working condition at all times. Periodic inspection, cleaning, maintenance of equipment shall be done.

16.4 The clinic or polyclinic shall have desired beds for observation or short stay facility.

16.5 The clinic or polyclinic shall have basic minimal essential drugs as per Appendix 6; however other drugs as per the scope of service being practiced may also be available.

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

17 Support Service

7.1 In a Clinic or polyclinic, minimum one support staff must be available to meet the care treatment and service needs of the patient. However number may depend upon the workload and scope of the service being provided by the clinical establishment.

18 LegalorStatutory Requirements

S. No

Name of the Act or License

Department or Area

Licensing body

Registration of medical doctor with Central or State Medical Council

Administration

MCI or State Medical Council

Biomedical Management & Rules, 2016

Administration

State Pollution Control Board

Local registration of the Clinic

Administration

State Council

Pharmacy License

Administration

Indian Pharmacy Council (If applicable)

USG

Administration

PC-PNDT

Approval for X-ray if available

Administration

AERB

Record Maintenance and reporting

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

10. Process

10.1Registration

10.1.1 Every patient visiting the clinic shall be registered.

Patient shall be guided and informed regarding Patients’ Rights and Responsibilities Appendix 7

10.2Assessment

10.2.1 Each patient shall undergo an initial assessment, which would include

measurement of the vitals, height & weight.

10.2.2 The same shall be documented in an assessment or O.P.D. card.

10.2.3 During the course of assessment, the patient findings, medications and investigations shall also be documented legibly in the card with the signature of the consultant or Specialist or super specialist, date and time.

10.2.4 No medicines shall be dispensed from pharmacy store (if facility available) without a written prescription order of doctor, except in emergency cases. Medication dispensing shall be done with care to prevent any medication error. Following shall be checked before dispensing of medication. These checks shall be done at store level:

10.2.4.1 10.2.4.2 10.2.4.3 10.2.4.4 10.2.4.5

Medicine prescribed.

Dose of prescribed medicine.

Expiry date.

Particulate matter in liquid dosage forms and parenteral drugs Labels (if reconstituted drugs).

10.2.5 Labeling shall be done for every prepared or reconstituted medication, which shall include name, date of preparation, strength and frequency of administration of drug.

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

10.2.6 The availability of support staff including nursing is essential to ensure safe observation or short stay facility.

10.3Infection Control

10.3.1 The clinic shall take all precautions to control infections like religiously

practicing hand washing.

10.3.2 Availability of running tap water for hand washing or liberal use of sanitizer shall be maintained throughout the working hours of the clinic.

10.3.3 The clinic environment shall be kept clean.

10.3.4 Sanitation and hygiene of the toilets shall be maintained.

10.3.5 Mopping of all areas with disinfectant shall be done at least once a day.

10.4.1 There shall be no seepage in walls or any blockade of drains. There shall be provision of air circulation. Effort shall be made to keep clinic pest and termite free. Availability of mosquito net on windows shall be ensured by the clinician.

10.5Biomedical waste Management

10.5.1 Clinic waste generated shall be segregated at source.

10.5.2 Biomedical waste shall be managed in accordance with the BioMedical Waste management Rules, 2016.

10.5.3 Needles shall be destroyed with the help of a needle destroyer before putting them in tamper proof, leak proof and puncture proof container.

10.6.1 Appropriate facility for First Aid shall be available.

10.4

Safety Considerations

10.6

First aid & basic life support

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

Minimum area required for a clinic:

APPENDIX 1

Infrastructure requirement (Desirable)

LOCATION

AREA REQUIRED

REMARKS

Common area (Reception and waiting)

35 sq ft carpet area

Consultation room (ancillary area)

70 sq ft

Area specified under consultation room is only for single clinic and shall be multiplied accordingly by the number of consultation chambers.

Store and pharmacy

40 sq ft

Observation and short stay (if applicable)

65 sq ft or bed

For X-Ray or USG, if applicable

As per laws applicable

Note: Reception, waiting, consultation room etc shall be adequate as per the requirement and workload of the clinic.

Ancillary area or space: Storage of records, reagents, consumables, stationery etc eating area for staff

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

APPENDIX 2

Furniture or fixtures

S.No.

Articles

Table

Chairs

Examination Table or couch

Screens

Foot Step

Stools

Storage Cabinet for medicine, records etc.

Bed(s) for observation

BMW storage area

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

APPENDIX- 3

I. Essential Equipment:

S. No.

Name of the equipment

Minimum Specifications

No. Of equipment

Stethoscope

Thermometer

(Non Mercury)

Torch (flash lights)

Tongue depressor

Measuring Tape

Sphygmomanometer (B.P. Apparatus)

(Non Mercury)

Height measuring Scale

Needle Destroyer

Weighing machine(Optional)

Adult

Bed(s)

1 or more

IV stand

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

APPENDIX- 4

I. Emergency Equipment:

S. No.

Name of the equipment

Minimum Specifications

No. of equipment

Resuscitation Equipment Ambu Bag or Air Way

– Adult

– Pediatric

1 1

Oxygen Cylinder (Portable)

Fire Extinguisher

ABC Type

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

APPENDIX – 5

Specialty wise Equipment List 1. Cardiology

2. Cardiothoracic Surgery

3. ENT

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

ECG Machine

Pulse Oximeter

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

ECG Machine

Pulse Oximeter

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Examination instruments set(speculums, mirrors, Bull’s lamp)

Diagnostic Otoscope

Head Light

Oesophagoscope Adult

(Desirable)

Oesophagoscope Child

(Desirable)

Laryngoscope

(Desirable)

Tuning Fork

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

4. Endocrinology

5. Gastroenterology

6. General Medicine

7. Gynaecology & Obstetrics

8. Neurosurgery

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Glucometer

S. No.

Name of the equipment

Minimum

Specifications

Number of

equipment

Proctoscope

Surgical Gloves

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

ECG Machine

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Sim’s vaginal speculum

Infantometer

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

EMG Machine

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

9. Neurology

10. Ophthalmology

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

EMG Machine

S. No.

Name of the equipment

Minimum

Number of

Ophthalmoscope

Specifications

equipment

Slit Lamp

Retinoscope

Perimeter

Distant Vision Charts

Near Vision charts

Trial Frame Adult or Children

Trial Lens Set

11. Orthopaedics

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Ortho Fracture Table

Skeleton traction set

Cramer wire splints

Thomas Splint

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

12. Paediatrics

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Nebulizer baby

Weighing machine infant

13. Tuberculosis and Respiratory Disease

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Spirometer

Nebulizer

Face mask

Peak Air flow meter

14. Urology

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Uroflowmeter

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

APPENDIX- 6

I. Essential Drugs

S. No.

Name of the Drug

Minimum Quantity

Injection Adrenaline

2 Ampoules

Injection Hydrocortisone

1 vial

Injection Atropine

1 Ampoule

Injection Pheniramine maleate

1 Ampoule

Injection Promethazine

1 Ampoule

Injection Deriphylline

1 Ampoule

Injection Frusemide

1 Ampoule

Injection Metoclopramide

1 Ampoule

Injection Dexamethasone

1 Ampoule

Injection. Diazepam

1 Ampoule

Injection Dicyclomine Hydrochloride

1 Ampoule

Injection 5% dextrose infusion

1 Vac

Injection. Normal saline

1 Vac

Note: Other drugs as per the scope of service being practiced may also be available.

Clinical Establishments Act Standards for Clinic or Polyclinic with Dispensary /Clinic-002

APPENDIX 7

Patients’ Rights and Responsibilities: Patients’ Rights

A patient and his or her representative has the following rights with respect to the clinical establishment-

21. To adequate relevant information about the nature, cause of illness, proposed investigations and care, expected results of treatment, possible complications and expected costs;

22. Rate of services provided by the clinical establishment would be displayed prominently.

23. To access a copy of case papers, patient records, investigations reports and detailed bill.

24. To informed consent prior to specific tests or treatment (e.g. surgery, chemotherapy)

25. To seek second opinion from an appropriate clinician of patients’ choice, with records and information being provided by treating hospital

26. To confidentiality, human dignity and privacy during treatment.

27. To have ensured presence of a female person, during physical examination of

a female patient by a male practitioner.

28. To non-discrimination about treatment and behaviour on the basis of HIV

status

29. To choose alternative treatment if options are available

30. Rate of services provided by the clinical establishment would be displayed

prominently.

Patients’ Responsibilities

Provide all health related information

Cooperate with Doctors during examination, treatment

Follow all instructions

Pay hospitals agreed fees on time

Respect dignity of doctors and other hospital staff

Never resort to violence

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

Clinical Establishments Act Standard for Clinic or Polyclinic with Observation or Short Stay

Standard No.CEA/ Clinic- 004

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

Table of Contents

Particulars

Page No.

Definition

Scope (as applicable)

Infrastructure

Furniture & Fixture

Human Resource

Equipment or Instruments or Drugs

Support Service

Legal or Statutory Requirements

Record Maintenance and Reporting

Process

Appendix -1

Appendix -2

Appendix -3

Appendix -4

Appendix -5

Appendix -6

Appendix -7

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

Clinicor Polyclinic with Observation or Short Stay

20 Definition

20.1 A clinic with observation or short stay may be defined as a healthcare facility providing examination, consultation, prescription to outpatients by a single general practitioner or group of general practitioners or specialist doctor or super-specialist doctor and carrying out few minor procedures like dressing and administering Injections with observation or short stay facility.

20.2 A polyclinic with observation or short stay may be defined as a healthcare facility providing consultation to outpatients by more than one doctor or general practitioner or specialist doctor or super-specialist doctor and carrying out few minor procedures like dressing and administering Injections with observation or short stay facility.

20.3 Observation or short stay facility would be available.

21 Scope (as applicable)

21.1 These set of common minimum standards framed are applicable to a single practitioner or more than one doctor clinic manned by a General physician or specialist doctor or super specialist or a group of doctors who are providing patient care services like dispensing of medicines, Injection and dressing, family planning with observation or short stay facility.

21.2 To provide examination, consultation, prescription to outpatients by a single doctor or general physician or specialist doctors or super-specialist doctor or group of doctors who are providing patient care services like dispensing of medicines, Injection and dressing with observation or short stay facility.

21.3 To deliver primary service in health education and health promotion;

21.4 To deliver health care services of rehabilitative nature.

21.5 Any or more than one of the following are included:

a) General Physician

b) Cardiology

c) Cardiothoracic surgery

d) Dermatology

e) ENT

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

f) Endocrinology

g) Gastroenterology

h) Internal Medicine

i) General Surgery

j) Gastro Intestinal Surgery

k) Gynaecology & Obstetrics

l) Medical Oncology

m) Surgical Oncology

n) Nephrology

o) Neurosurgery

p) Neurology

q) Ophthalmology

r) Orthopedics

s) Pediatrics

t) Pediatric surgery

u) Psychiatry

v) Rheumatology

w) Thoracic surgery

x) Tuberculosis and Respiratory s

y) Urology

22 Infrastructure

22.1 The physical facility shall be developed and maintained to provide safe and secure environment for patients, their families, staff and visitors. It shall be situated in a place having clean surroundings and shall comply with municipal byelaws in force from time to time.

22.2 The minimum space requirement for carrying out the basic functions of the facility shall be as per Appendix 1.

22.3 The area shall be well illuminated, ventilated and clean with adequate water supply.

22.4 The clinic shall have a prominent board or signage displaying the name of the clinic in local language at the gate or on the building of the clinic.

22.5 The following other signage shall be well displayed in the language understood by the local public in the area:

a) Name of the doctors with registration number.

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

b) Fee structure of the various doctors or specialists

c) Timings of the clinics (For e.g. from 8am -2pm)

d) Services provided within the Facility

23 Furniture & Fixtures

23.1 Furniture and fixtures shall be available in accordance with the activities and workload of the Clinic or Polyclinic.

23.2 The furniture and fixtures shall be functional all the time. For indicative list of items refer Appendix 2. This list is indicative and not exhaustive.

24 Human Resource

24.1 The general practitioner or specialist doctor or super-specialist doctors as per the scope of the clinic or polyclinic shall be registered with State or Central Medical Council of India.

24.2 The services provided by the medical professionals shall be in consonance with their qualification, training, registration.

24.3 In a polyclinic, minimum one support staff must be available to meet the care treatment and service needs of the patient. , number may depend upon the workload and scope of the service being provided by the clinical establishment.

25 Equipment o rinstruments or drugs

25.1 The clinic or polyclinic shall have essential equipments as per Appendix3, emergency equipment Appendix 4 and other equipments as per the scope of service being practiced as per Appendix 5.

25.2 Adequate space for storage of medicines equipments etc shall be provided. The equipment shall be of adequate capacity to meet work load requirement.

25.3 All equipment shall be in good working condition at all times. Periodic inspection, cleaning, maintenance of equipment shall be done.

25.4 The clinic or polyclinic shall have desired beds for observation or short stay facility.

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

25.5

7.1

The clinic or polyclinic shall have basic minimal essential drugs as per Appendix 6; however other drugs as per the scope of service being practiced may also be available.

Support Service

In a Clinic or polyclinic, minimum one support staff must be available to meet the care treatment and service needs of the patient. However, number may depend upon the workload and scope of the service being provided by the clinical establishment.

LegalorStatutory Requirements

S. No

Name of the Act or License

Department or Area

Licensing body

Registration of medical doctor with Central or State Medical Council

Administration

MCI or State Medical Council

Biomedical Management Rules, 2016

Administration

State Pollution Control Board

Local registration of the Clinic

Administration

State Council

Pharmacy License

Administration

Indian Pharmacy Council

28.1

28.2

Record Maintenance and reporting

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

10. Process

10.1Registration

10.1.1 Every patient visiting the clinic shall be registered.

10.1.2Patient shall be guided and informed regarding Patients’ rights &

responsibilities. Appendix 7 10.2Assessment

10.2.1 Each patient shall undergo an initial assessment, which would include measurement of the vitals, height & weight.

10.2.2 The same shall be documented in an assessment or O.P.D. card.

10.2.4.1 10.2.4.2 10.2.4.3 10.2.4.4 10.2.4.5

Medicine prescribed.

Dose of prescribed medicine

Expiry date.

Particulate matter in liquid dosage forms and parenteral drugs. Labels (if reconstituted drugs).

10.2.5 Labeling shall be done for every prepared or reconstituted medication, which shall include name, date of preparation, strength and frequency of administration of drug.

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

10.2.6 The availability of support staff including nursing is essential to ensure safe observation or short stay facility.

10.3Infection Control

10.3.1 The clinic shall take all precautions to control infections like religiously

practicing hand washing.

10.3.2 Availability of running tap water for hand washing or liberal use of sanitizer shall be maintained throughout the working hours of the clinic.

10.3.3 The clinic environment shall be kept clean.

10.3.4 Sanitation and hygiene of the toilets shall be maintained.

10.3.5 Mopping of all areas with disinfectant shall be done at least once a day.

10.4. Safety Considerations

10.4.1 Floor shall have even surface and be non slippery in nature. There shall be no seepage in walls or any blockade of drains. There shall be provision of air circulation. Effort shall be made to keep clinic pest and termite free. Availability of mosquito net on windows shall be ensured by the clinician.

10.5Biomedical waste Management

10.5.1 Clinic waste generated shall be segregated at source.

10.5.2 Biomedical waste shall be managed in accordance with the BMW management Rules, 2016.

10.5.3 Needles shall be destroyed with the help of a needle destroyer before putting them in tamper proof, leak proof and puncture proof container.

10.6First aid & basic life support

10.6.1Appropriate facility for First Aid shall be available.

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

Minimum area required for clinic shall be as follows:

APPENDIX –1

Infrastructure Requirement (Desirable)

LOCATION

AREA REQUIRED

Common area (Reception and waiting)

35 sq ft carpet area

Consultation room (ancillary area)

70 sq ft carpet area including storage

Area specified under consultation room is only for single clinic and shall be multiplied accordingly by the number of consultation chambers.

Store and pharmacy

40 sq ft

Observation and short stay (if applicable)

65 sq ft or bed

Note: Reception, waiting, consultation room etc shall be adequate as per the requirement and workload of the clinic.

Ancillary areaorspace: Storage of records, reagents, consumables, stationery etc

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

APPENDIX 2

Furniture or fixtures

S. No

Articles

Table

Chairs

Examination Table or couch

Screens

Foot Step

Stools

Storage Cabinet for medicine, records etc.

Bed(s) for observation or short stay

BioMedical Waste storage area

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

I. Essential Equipment.

APPENDIX 3

Equipment or Instruments

S. No.

Name of the equipment

Minimum Specifications

No. Of equipment

Stethoscope

Thermometer

(Non Mercury)

Torch (flash lights)

Tongue depressor

Measuring Tape

Sphygmomanometer(B.P. Apparatus)

(Non Mercury)

Height measuring Scale

Needle Destroyer

Weighing machine(Optional)

Adult

Bed(s)

1 or more

IV stand

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

APPENDIX 4

II. Emergency Equipment:

S. No.

Name of the equipment

Minimum Specifications

No. of equipment

1 1

Resuscitation Equipment Ambu Bag or Air Way

Oxygen Cylinder (Portable)

– Adult

– Pediatric

Fire Extinguisher

ABC Type

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

APPENDIX – 5

Specialty Wise Equipment List: I. Cardiology

II. Cardiothoracic Surgery

III. ENT

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

ECG Machine

Pulse Oximeter

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

ECG Machine

Pulse Oximeter

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Examination instruments set (speculums, mirrors, Bull’s lamp)

Diagnostic Otoscope

Head Light

Oesophagoscope Adult

(Desirable)

Oesophagoscope Child

(Desirable)

Laryngoscope

Tuning Fork

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

IV. Endocrinology

V. Gastroenterology

VI. General Medicine

VII. Gynecology& Obstetrics

VIII. Neurosurgery

IX. Neurology

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Glucometer

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Proctoscope

Surgical Gloves

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

ECG Machine

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Sim’s vaginal speculum

Infantometer

S. No.

Name of the equipment

Minimum Specifications

No. of equipment

EMG Machine

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

EMG Machine

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

X. Ophthalmology

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Ophthalmoscope

Slit Lamp

Retinoscope

Perimeter

Distant Vision Charts

Near Vision charts

Trial Frame AdultorChildren

Trial Lens Set

XI. Orthopedics

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Ortho Fracture Table

Skeleton traction set

Cramer wire splints

Thomas Splint

XII. Pediatrics

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Nebulizer baby

Weighing machine infant

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

XIII. Tuberculosis and Respiratory Disease

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Spirometer

Nebulizer

Face mask

Peak Air flow meter

XIV. Urology

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Uroflow meter

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

APPENDIX- 6

I. Essential Drugs

S. No.

Name of the Drug

Minimum Quantity

Injection Adrenaline

2 Ampoules

Injection Hydrocortisone

1 vial

Injection Atropine

1 Ampoule

Injection Pheniramine maleate

1 Ampoule

Injection Promethazine

1 Ampoule

Injection Deriphylline

1 Ampoule

Injection Frusemide

1 Ampoule

Injection Metoclopramide

1 Ampoule

Injection Dexamethasone

1 Ampoule

Injection.Diazepam

1 Ampoule

Injection. Dicyclomine Hydrochloride

1 Ampoule

Injection 5% dextrose infusion

1 Vac

Injection Normal saline

1 Vac

Note: Other drugs as per the scope of service being practiced may also be available.

Clinical Establishments Act Standards for Clinic or Polyclinic with Observation or Short Stay CEA/Clinic-004

APPENDIX 7 Patients’ rights and responsibilities:

Patients’ rights

A patient and his or her representative has the following rights with respect to the clinical establishment-

31. To adequate relevant information about the nature, cause of illness, proposed investigations and care, expected results of treatment, possible complications and expected costs;

32. Rate of services provided by the clinical establishment would be displayed prominently.

33. To access a copy of case papers, patient records, investigations reports and detailed bill.

34. To informed consent prior to specific tests or treatment (e.g. surgery, chemotherapy)

35. To seek second opinion from an appropriate clinician of patients’ choice, with records and information being provided by treating hospital

36. To confidentiality, human dignity and privacy during treatment.

37. To have ensured presence of a female person, during physical examination of

a female patient by a male practitioner.

38. To non-discrimination about treatment and behaviour on the basis of HIV

status

39. To choose alternative treatment if options are available

40. Rate of services provided by the clinical establishment would be displayed

prominently.

Patients’ responsibilities:

Provide all health related information

Cooperate with doctors during examination, treatment.

Follow all instructions

Pay hospital’s agreed fees on time

Respect dignity of doctors and other hospital staff

Never resort to violence

Clinical Establishments Act Standards for Health Checkup Centres-CEA

Clinical Establishments Act Standard

for

Health Check up Centres

Standard No.CEA or Health Check up Centre

Clinical Establishments Act Standards for Health Checkup Centres-CEA

Table of Contents

Particulars

Page No.

Definition

Scope (as applicable)

Infrastructure

Furniture & Fixtures

Human Resource

Equipment or Instruments or Drugs

Appendix 1

Appendix 2

Appendix 3

Appendix 4

Appendix 5

Appendix 6

Clinical Establishments Act Standards for Health Checkup Centres-CEA

Health Checkup Centre

29 Definition

The standards for Health Checkup Centre are framed based on the basic functions of the unit or centre or provider.

Type of Services

Scope of Services

Health Checkup

Health Checkup is interventions that do not require overnight stay at the centre for medical reasons; leaving the treatment after any stage should not cause any harm to the individual.

30 Scope (as applicable)

2. This includes the services being provided by the facility to which the standards will be applicable.

2.1. List of services: The scope of services that may be provided at an centre may include services in any or all of the following specialties, but not necessarily limited to:

Specific Services under each category to be decided by the centre

Health Checks e.g., Health Check up

Laboratory services

Imaging services

Fitness check

Consultation – Optional

2.2. List of Support Services:

2.2.1 Laboratory services to be available either in-house or outside the centre.

2.2.2 Imaging services to be available either in-house or outside the centre.

Sr. no.

Support Service

Applicability

Accounting

Optional

Billing

If Applicable

Essential commodities like water supply, electric supply etc.

Applicable

Finance

Optional

Financial accounting and auditing

As required by Law

Housekeeping and Sanitation

Applicable

Inventory Management

Optional

Clinical Establishments Act Standards for Health Checkup Centres-CEA

Laundry services

Optional

Medical records

Applicable

10.

Office Management (Provision should be made for computerized medical records with anti-virus facilities whereas alternate records should also be maintained)

Applicable

11.

Personnel Department

Optional

12.

Pharmacy or Dispensary

Optional

13.

Purchase

Applicable

14.

Reception

Applicable

15.

Security services

Optional

16.

Stores

Optional

17.

Waste management Housekeeping or sanitation

Applicable

18.

Equipment Management

Applicable

31 Infrastructure Requirements

31.1 Basic signage- A signage within or outside the facility shall be made available containing the following information.

31.1.1 A signage within or outside the facility should be made available containing the following information.

31.1.2 All signage meant for customer and visitors shall be bilingual 31.2 Following informative signage shall be displayed:

31.2.1 Name of the care provider with registration number

31.2.2 Name of organization.

31.2.3 Display of Registration under clinical establishments act

31.2.4 Fee structure

31.2.5 Availability of tariff list.

31.2.6 Timings of the facility

31.2.7 Availability of timings with names and respective specializations

31.2.8 Services provided

31.2.9 Directional signage for customers for utilities and conveniences like toilets, drinking water, telephone booths, shops.

31.2.10 Display of Health checks centre scope of services

Clinical Establishments Act Standards for Health Checkup Centres-CEA

31.2.11 Floor Plan With Location Of Departments

31.2.12 Plan of Facility, if stand-alone building.

31.3

Following safety signage shall be displayed:

31.3.1 Safety Hazard and Caution signs

31.3.2 Display of all radiation hazard signage in radiation areas (if applicable).

31.3.3 Display of Biomedical waste segregation at all location where BioMedical

Waste bins are kept

31.3.4 Display of danger signage at all electric panels and other dangerous areas

31.3.5 Display of General instructions like ‘No Smoking’, ‘Keep Silence’, ‘Use dustbin’, etc. at various customer and visitor areas in the hospital

31.3.6 Display of important phone contact numbers of hospital authorities

31.3.7 Displays required by regulations like PCPNDT Act, Lifts, Fire, etc.

31.3.8 Display of patients rights and responsibilities

31.3.9 Display of safety instructions in areas where any kind of safety hazard may be expected. This includes areas like transformers, Cylinder storage, LPG storage etc

31.3.10 Hazards- electrical, fall, pipe locations, prohibited areas

31.3.11 Signage for parking. (Signage for ambulance parking shall be separately

mentioned)

31.3.12 Appropriate Fire exit signages

31.3.13 Display of how to use fire extinguisher at all point where fire extinguisher

is installed

31.3.14 Emergency exit signage (preferably in auto illumination material, like radium)

Clinical Establishments Act Standards for Health Checkup Centres-CEA

3.4. Functional space planning of the facility like reception area, waiting area should be as per the scope of services.

i. ii. iii. iv. v. vi.

i. ii.

iii.

i. ii. iii.

i. i.

i. ii. iii. iv. v.

vi. vii.

3.4.1 Consultation & examination room

Consultation room should be adequate to accommodate: Table for Consultancy

Consultation chair,

Two stools or chairs,

Examination bed, if necessary, will be of the size 6 ft X 2.5 ft., Privacy screen around examination area while having free mobility

3.4.2 Laundry (optional)

Laundry services can be in-house or outsourced.

If it is provided in house, it should have necessary facilities for drying, pressing and storage of soiled and cleaned linens.

If outsourced, quality of outsourced work is monitored by the organization.

3.4.3 House-Keeping:

Housekeeping services should be made available for effective cleanliness. Housekeeping services can be outsourced.

A designated area within functional areas for safe storage of housekeeping materials has to be in centre.

3.4.4 Security Services:

There is a designated location for security staff on duty. 3.4.5 Clinical laboratory specifications:

Laboratory services to be available either in-house or outside the Hospital for quick diagnosis of blood, urine, etc.,

3.4.6 Radiology section

Imaging services to be available either in-house or outside the Hospital.

The department should be located at a place which is accessible to customers. The size of the room should depend on the type of instrument installed.

It should confirm to Atomic Energy Regulatory Board requirements.

The room should have a sub-waiting area with toilet facility and a change room facility, if required.

Film developing and processing (dark room) shall be provided in the department for loading, unloading, developing and processing of X-ray films.

Separate Reporting Room for doctors should be provided.

Clinical Establishments Act Standards for Health Checkup Centres-CEA

i. ii. iii.

i. ii.

i. ii. iii.

3.4.7 Customer or Medical record-room:

Customer or Medical record-storage should be of adequate size as per the load of the documents of the centre.

Tamperproof material and locking facility Cabinets or cupboards or Boxes should be used.

Fire extinguishers of correct type should be made available nearby all locations.

3.4.8 Store rooms:

Store room should be lockable & of adequate size with exhaust fan.

Area should be clean, well ventilated, well lit, without any dampness or fungal growth on walls.

3.4.9 Duty rooms for doctors

To accommodate 1 bed of 6 feet X 3 feet and a side table. Separate beds if sharing for same gender.

Separate rooms for separate genders will be provided.

3.4.10 Duty rooms for technicians:

To accommodate 1 bed of 6 feet X 3 feet and a side table. Separate beds if sharing for same gender.

Separate rooms for separate genders will be provided.

3.4.11 Dirty utility room:

Separate area of minimum 15 sq feet.

Furniture &Fixtures

32.1 Furniture and fixtures shall be available in accordance with the services and workload of the centre. For indicative list refer to Appendix 1.

32.2 The furniture and fixtures shall be functional all the time.

33 Human Resource

33.1 A suitably qualified and individual heads the organization and manages in ethical manner. For detail refer to Appendix 2.

33.2 The technical staff employed should have the relevant education or registration, training and experience to provide service to customer care without supervision.

33.3 The additional staff member shall be adequately trained on specific job duties or responsibilities related to customer safety and well being.

Clinical Establishments Act Standards for Health Checkup Centres-CEA

33.4 Personnel record containing personal and professional information shall be maintained for each staff.

33.5 Periodic skill enhancement or upgradation or refresher trainings shall be provided for all categories of the staff relevant to their job profile.

34 Equipment or Instruments

34.1 The centre shall have equipment or instruments as per the scope of services provided. For indicative list refer to Appendix 3

34.2 Adequate space for placement and usage of equipment and Instruments shall be provided.

34.3 The equipment should be of adequate capacity to meet work load requirement.

34.4 All equipment should be in good working condition at all times. Periodic inspection, cleaning, maintenance of equipment should be done.

35 Drugs and Consumables

35.1 Drugs and consumables as per the scope of services provided. For indicative list refer to Appendix 4.

35.2 Storage of drugs, cosmetic and consumables shall be stored as per manufacturer’s guidelines.

35.3 The drugs are handled by appropriate personnel in accordance of the regional, local and national regulations.

For Legal requirement refer to Appendix 5 For record maintenance refer to Appendix 6

Clinical Establishments Act Standards for Health Checkup Centres-CEA

APPENDIX 1 Furniture or fixture

I. Furniture or Fixture Requirements: as per the scope of services

Sr. No.

Name of the Equipment

Health checks Centre

Adequate lockable storage space

As per requirement

Air conditioning

As per requirement

An examination table of 6 ft. X 2.5 ft. With privacy screen

As per requirement

Blood pressure apparatus

1 per Centre

Ceiling Fans

As per requirement

Clock 1 per Centre

1 per Centre

Computers (if required)

1 per Centre

Consultant’s chair

As needed

Consultant’s or Office table

1 per Centre

10.

Duty table for staff

1 per Centre

11.

Emergency resuscitation kit

1 per Centre

12.

Essential diagnostic tools required for examination of customer as per the scope of services offered by the Centre.

As per requirement

13.

Fire extinguisher

ABC 1 per ward or floor based on layout

14.

Foot stools

1 per consultation room

15.

Heavy duty Torch light

1 per Centre

16.

Hot Water Bags

As per requirement

17.

Hot Water geyser

As per requirement

18.

Light source which gives light colour and temperature similar to solar light,

Light intensity of at least 500 lux at the point of examination.

As per requirement

19.

Office chairs

1 per Centre

20.

Customer locker

1 per Centre

21.

Refrigerator if temperature sensitive medication are stored (if required)

1 per Centre

22.

Steel or Wooden cup board

As per requirement

23.

Steel rack

As per requirement

24.

Stethoscope

1 per Centre

Clinical Establishments Act Standards for Health Checkup Centres-CEA

25.

Stools

As per requirement

26.

Stools revolving

2 per Centre

27.

Hammock Stretcher or Stretcher or Customer trolley – 1 per Centre

1 per Centre

28.

Telephone or Fax equipment

As per requirement

29.

Thermometer

1 per Centre

30.

Waiting chairs or benches for customer’s relatives

50% of the customer strength

31.

Weighing machine

1 per Centre

32.

Wheel chair

1 per Centre

33.

X-ray viewer

1 per Centre

II. Other Furniture or Fixture Requirements

Sr. No.

Name of the Equipment

Health checks Centre

Air conditioners Central AC

As per requirement

Computer with modem with UPS, printer with internet connection

As needed

Coolers

As needed

Drinking Water purifier

As needed

Emergency lamp

2 Per Area or Ward

Exhaust Fan

As needed

Fire extinguishers

As needed

Geyser

1 per ward

Refrigerator

1 per ward

10.

Tables & Chairs

As needed

11.

Telephone or cell phone

1 per ward

12.

Tube lights

As needed

13.

Vacuum cleaner

As needed

14.

Computer with Modem with UPS, Printer with Internet Connection

As needed

15.

Photocopy Machine

As needed

16.

Intercom (10 lines)

As needed

17.

Fax Machine

As needed

Clinical Establishments Act Standards for Health Checkup Centres-CEA

APPENDIX 2

Human Resource Requirement

1. This includes the Designation, minimum qualification & number of people required in the facilityas per the scope of services.

1.1Medical practitioners

1. Category: MBBS Doctors.

2. Minimum Qualifications: Degree or Post Graduate Degree from recognized

university. Registration: (if applicable): with state or central council related to

the profession.

3. Trained or skilled: Trained

1.2 Nurses:

ANM or GNM or BSc or MSc nurses,

One per shift per for 50% of the total number of consulting room

1.3 Paramedics

1. Category: Paramedics

2. Minimum Qualifications: (diploma or degree from recognized university.)

3. Registration with the concerned council(if applicable): state or central council

4. Trained or skilled: Trained

Sr. no.

Health Checks

As per Allopathy standards in relevant specialties as the profile of checkup provided at the centre

Sr. no

Paramedics

Minimum qualification

Health Checks

ECG Technician

(if ECG services are provided in-house)

1 year experience of taking ECG

As per requirement

Laboratory Attendant (if lab is in-house)

Ability to read national or local language

As per requirement

Laboratory Technician (if Laboratory is in- house)

Qualified Laboratory Technician

As per requirement

Medical Records Officer or Technician

Minimum qualification- 12th Standard passed.

As per requirement

Radiographer

(if Imaging is in-house)

Qualified Radiographer

As per requirement

Ward Ayah

Eight standard completed

As per

Clinical Establishments Act Standards for Health Checkup Centres-CEA

requirement

Ward boy

Eight standard completed

As per requirement

1.4. Administrative staff: The number would vary as per scope of the centre or requirement and may be outsourced.

Administrative staff

Sr. no

Administrative staff

Health Checks

Office Administrator

As per requirement

Accountant

As per requirement

Multipurpose worker

As per requirement

Clinical Establishments Act Standards for Health Checkup Centres-CEA

APPENDIX 3 Equipment or Instrument

Following emergency equipment shall be available as follows:

Sr. No.

Emergency Equipment

Health Checks Centre

Emergency equipment box for first aid & BLSS

Minimum 1

Crash-Cart trolley:1

Minimum 1

Portable defibrillator:1

Optional

Disposable syringes

As needed

Ambu Bag:1

Minimum 1

Laryngoscope with cells & adult and pediatric blades

Minimum 1

Sealed battery cell

Minimum 1

Endotracheal tubes

As needed

Pulse Oxymeter

Minimum 1

10.

Suction Apparatus

Minimum 1

11.

ECG Machine

Minimum 1

12.

BP Apparatus & Stethoscope

Minimum 1

13.

Oxygen cylinders with flow meter or tubing or catheter or face mask or nasal prongs

Minimum 1

Other necessary and sterilizing equipment as per the scope of services shall also be available.

Clinical Establishments Act Standards for Health Checkup Centres-CEA

APPENDIX 4

Drugs, Medical devices and Consumables

I. Emergency drugs:

Category: Emergency Drugs

Sr. no. Name of the Drug Minimum Quantity

Strength

As per I.P.

Injection Adrenaline Minimum 10 Ampoules or Vials

2. Injection Atropine Minimum 10 Ampoules or Vials

Injection Calcium Minimum 10 Ampoules or Vials Carbonate

Injection Dopamine Minimum 10 Ampoules or Vials Injection Dobutamine Minimum 10 Ampoules or Vials Injection Nitroglycerine Minimum 10 Ampoules or Vials

7. Injection Sodium Minimum 10 Ampoules or Vials

8. 9.

Bicarbonate

Injection Hydrocortisone Minimum 10 Ampoules or Vials Inhaler Beclomethasone Minimum 10 Ampoules or Vials (250 microordose)

10. Inhaler Salbutamol (200 Minimum 10 Ampoules or Vials micrograms)

11. 12.

13. 14.

Injection Frusemide Minimum 10 Ampoules or Vials Injection Diazepam or Minimum 10 Ampoules or Vials Midazolam

Injection. Deriphylline Minimum 10 Ampoules or Vials Injection. Phenytoin Minimum 10 Ampoules or Vials sodium

15. Injection Pheniramine Minimum 10 Ampoules or Vials maleate (Avil)

16. Injection 17. Injection

Ondansetrone Minimum 10 Ampoules or Vials KCl Minimum 10 Ampoules or Vials Lignocaine 2% Minimum 10 Ampoules or Vials Amiodarone Minimum 10 Ampoules or Vials Magnesium Minimum 10 Ampoules or Vials

Mannitol Minimum 10 Ampoules or Vials Morphine or Minimum 10 Ampoules or Vials Pethidine

24. Injection. Fentanyl Minimum 10 Ampoules or Vials 25. Water for Injection Minimum 10 Ampoules or Vials 26. Injection Sodium Valproate Minimum 10 Ampoules or Vials

18.

19.

20. Injection

Injection Injection

sulphate

23.

Injection

21.

22. Injection

Injection

Injection. Noradrenaline Minimum 10 Ampoules or Vials bitartrate

27.

28.

29. Mannitol Injection Minimum 10 Ampoule or Vials 30. Metoprolol Injection Minimum 10 Ampoules or Vials

Injection Voveran Minimum 10 Ampoules or Vials Injection Paracetamol Minimum 10 Ampoules or Vials

Nor2 saline Injection Minimum 10 Ampoules or Vials Oxytocin Injection Minimum 10 Ampoules or Vials

31.

32. Oxygen Inhalation

33.

Clinical Establishments Act Standards for Health Checkup Centres-CEA

II. Linen

Sr. no

Linen

Quantity

Bed sheets

As per requirement

Bedspreads

As per requirement

Blankets

one per bed

Curtain cloth for windows and doors

As per requirement

Overcoat for consultant

one per consultant

Mats (Nylon)

As per requirement

Mattress (foam) adults

As per requirement

Pediatric Mattress

one per bed

towels

As per requirement

10.

Pillow covers

As per requirement

11.

Pillows

As per requirement

12.

Table cloth

adequate quantity

13.

Uniform or Apron

As per requirement

III. Stationery as per the scope of services

Sr. no.

Items

Consent Forms

Consultant Reference Form

Continuation sheets

Diet Sheets

Initial Assessment Form

Pathological Books

Registers

Registration Card

Sentinel Event Form

10.

Supplementary Sheets

11.

X-ray Forms

Clinical Establishments Act Standards for Health Checkup Centres-CEA

APPENDIX 5

Legal or Statutory Requirements

This includes the minimum statutory compliance applicable as per the central or state government along with licensing body, wherever applicable.

Sr. no.

Name of the Act

Department or Area

Licensing body

Registration under Shops and Establishment Act

Organization

Jurisdictional Authorities like Panchayator Nagarpalika or Mahanagarpalika or Municipality or Municipal Corporation

Registration under Clinical Establishments Act

Organization

Jurisdictional Authorities like Panchayat or Nagarpalika or Mahanagarpalika or Municipality or Municipal Corporation

Agreement for Common Biomedical Waste Collection, Transportation, Treatment, Storage and Disposal Facility

Organization

Local Pollution Control Board

Registration under Air (prevention and control of pollution) Act, 1981.

Organization

Local Pollution Control Board

Building Permit (From the Municipality).

To be obtained from

Jurisdictional Revenue Authorities like Panchayat or Nagarpalika or Mahanagarpalika or Municipality or Municipal Corporation

Certificate uors 80-G of IT Act

Organization

If applicable.

ESI registration in case of >20 employees

Organization

Employee State Insurance Company

Excise permit to store Spirit.

Organization

Excise department

Generator Exhaust air Quality Report

Generator

Authorized Air Testing Laboratory

10.

License to sale or distribute drugs Form 20, 21, 21C

Pharmacy

FDA

11.

License for lift

Lift

Mobile Electric Vehicles

Clinical Establishments Act Standards for Health Checkup Centres-CEA

Department

12.

License to play music for public use

Organization

Indian

13.

Occupation Certificate

To be obtained from

Jurisdictional Revenue Authorities like Panchayat or Nagarpalika or Mahanagarpalika or Municipality or Municipal Corporation

14.

PC PNDT Act, 1996.

Sonography

Health Department of Regulatory Body assigned with the responsibility

15.

SMPV License for Storage of Liquid Oxygen, Form III (License to compressed gas in pressure vessel or vessels)

Medical Gases in Pressu rized Vessels

Licensing Authority

16.

TAN Number

Organization

Income Tax Department

17.

PAN Number

Organization

Income Tax Department

18.

Vehicle Registration certificates for Ambulance

Ambulance and Vehicles owned by the organization

Road Traffic Authority

19.

Water Prevention and control of pollution Act

Organization

Pollution Control Board

Clinical Establishments Act Standards for Health Checkup Centres-CEA

APPENDIX 6

Record Maintenance and reporting

1. Standard on record maintenance

Sr. no

Records

Customer reports records

Reports of investigations

Consents

2. Standard on content of record.

Sr. no.

Name of Forms

Registration number of treating doctor

Name and contact number

Relevant assessment

4. 5.

Advise or Treatment record

Imaging Report Format for each imaging modality

Laboratory Report Forms for each category of investigation

outcome

Clinical Establishments Act Standards for Mobile Clinic (only Consultation) and dispensary

CEA or Mobile Clinic 001

Clinical Establishments Act

Standard for

Mobile Clinic (only Consultation) and dispensary

Standard No.CEA orMobile Clinic- 001

Clinical Establishments Act Standards for Mobile Clinic (only Consultation) and dispensary

CEA or Mobile Clinic 001

Table of Contents

Particulars

Page No.

Definition

Scope

Infrastructure

Human Resource

Equipment or instruments or drugs

Record Maintenance and reporting

Process

Appendix – 1

Appendix – 2

Clinical Establishments Act Standards for Mobile Clinic (only Consultation) and dispensary

CEA or Mobile Clinic 001

Mobile Clinic with Consultation and Dispensary

36 Definition

The Mobile clinic may be defined as a facility on a vehicle or specially fabricated on a vehicle providing examination, consultation, prescription to outpatients including dispensing of medicines by a general practitioner or specialist or super-specialist doctor to those in remote or specified areas who have access to little or no medical facilities.

37 Scope

37.1 The operation of mobile clinics is to render general health care services to those in remote or specified areas who have access to little or no medical facilities.

37.2 The mobile clinics will visit the identified service point to provide health services to the identified community or area.

37.3 To deliver primary service in health education and health promotion.

37.4 The services offered may also include one or more than one specialty of allopathy medicine, AYUSH, Dental, wellness, etc. and allied services like Physiotherapy, in the mobile clinic.

37.5 Health records for all patients will be maintained to monitor the program and to facilitate follow-up treatments.

38 Infrastructure

38.1 Vehicle

38.1.1 The vehicle shall be kept clean to provide safe and hygienic care to the patients commensurate to the scope of the services provided.

38.1.2 The vehicle shall be registered as per local laws and regulations.

38.1.3 The vehicle shall prominently display the name and services provided which is easily visible to the community.

38.1.4 The vehicle shall have provision for hand hygiene.

38.1.5 The vehicle shall have appropriate communication facilities.

Clinical Establishments Act Standards for Mobile Clinic (only Consultation) and dispensary

CEA or Mobile Clinic 001

38.1.6 The vehicle shall be well illuminated and ventilated.

38.1.7 Furniture and fixtures shall be available in accordance with the activities and

workload and shall be kept functional.

39.1 The general practitioner or specialist or super-specialist shall be registered with respective state or central council of India as per the scope of the mobile clinic.

39.2 The services provided by the medical professionals shall be in consonance with their qualification, training, registration.

39.3 Periodic skill enhancement or up gradation or refresher trainings shall be provided for all categories of the staff relevant to their job profile.

39.4Personnel record containing personal and professional information shall be maintained for each staff.

39.5 Please refer below mentioned table for Manpower details. This list is indicative and not exhaustive.

39.6 Manpower

Human Resource

S. No

Category

Num ber

Minimum Qualifications from recognized university

Registration with the concerned council

(if applicable)

Doctor

MBBS

State or Central Medical council

Pharmacist

Diploma in Pharmacy.

Pharmacy Council of India

Desirable

Staff nurse

Qualified staff nurse with general nursing.

Indian Nursing Council

Counselor for HIVorAIDS counseling (Desirable)

Qualified staff nurse

Indian Nursing Council

Training required for counseling and lab techniques.

Driver

With requisite registration and licenses.

Clinical Establishments Act Standards for Mobile Clinic (only Consultation) and dispensary

CEA or Mobile Clinic 001

40 Equipment or instruments requirement

40.1 The mobile clinic shall have essential equipments as per APPENDIX I.

40.2 Other equipments as per the scope of service being practiced shall be available.

40.3 Adequate space for storage of equipments and medicines shall be provided.

40.4 If available, all medicines shall be stored as per manufacturer’s guidelines.

40.5 The equipment should be of adequate capacity to meet work load requirement.

40.6All equipment should be in good working condition at all times. Periodic inspection, cleaning, maintenance of equipment should be done.

40.7 The mobile clinic shall have basic minimal essential drugs as per APPENDIX II; however other drugs as per the scope of service being practiced may also be available.

41 Record Maintenance and reporting

41.1 Records shall be maintained in physical or digital format.

41.2 Confidentiality, security and integrity of records shall be maintained.

41.3 Every Clinical Establishment shall maintain medical records of patients treated by it and health information and statistics in respect of national programmes and furnish the same to the district authorities in form of quarterly reports.

41.4 Copies of all records and statistics shall be kept with the clinical establishment in accordance with CE Act under Section 12(1) (iii) of CEA 2010, or any other relevant Act in force at the time.

41.5 All clinical establishments shall be responsible for submission of information and statistics in time of emergency or disaster or epidemic situation or as required from time to time by National Council Clinical Establishments Act 2010.

42 Basic processes

42.1 Registration: Every patient visiting the mobile clinic shall be registered.

Clinical Establishments Act Standards for Mobile Clinic (only Consultation) and dispensary

CEA or Mobile Clinic 001

42.2Assessment: Every patient shall undergo assessment, during the course of assessment, the patient findings, medications and investigations should be documented with working diagnosis, legibly in the assessment or OPD prescription with the signature of the consultant or Specialist or super Specialist with date and time.

Clinical Establishments Act Standards for Mobile Clinic (only Consultation) and dispensary

Essential Equipments

Appendix 1

CEA or Mobile Clinic 001

S. No.

Name of the equipment

Minimum Specifications

Number of equipment

Stethoscope

Thermometer

(Non Mercury)

Torch (flash lights)

Sphygmomanometer(B.P. Apparatus)

(Non Mercury)

Weighing machine(Optional)

Adult

Clinical Establishments Act Standards for Mobile Clinic (only Consultation) and dispensary

Emergency Drugs

Appendix- II

CEA or Mobile Clinic 001

S. No.

Name of the Drug

Minimum Quantity

Injection Adrenaline

2 Ampoules

Injection Hydrocortisone

1 vial

Injection Atropine

1 Ampoule

Injection Pheniramine maleate

1 Ampoule

Injection Promethazine

1 Ampoule

Injection. Deriyphylline

1 Ampoule

Injection Frusemide

1 Ampoule

Injection Metoclopramide

1 Ampoule

Injection Dexamethasone

1 Ampoule

Injection Diazepam

1 Ampoule

Injection Dicyclomine Hydrochloride

1 Ampoule

Injection 5% dextrose infusion

1 Vac

Injection Normal saline

1 Vac

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

Clinical Establishments Act Standard for

Mobile Clinic with procedures in Local or Regional Anaesthesia

Standard No.CEA orMobile Clinic- 002

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

Table of Contents

Particulars

Page No.

Definition

Scope

Infrastructure

Human Resource

Equipment or instruments or drugs

Furniture & Fixtures

Record Maintenance and reporting

Process

Appendix – 1

Appendix – 2

Glossary

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

MOBILE CLINIC – With Procedures

43 Definition

The Mobile clinic may be defined as a facility on a vehicle or specially fabricated on a vehicle providing examination, consultation, prescription to outpatients including dispensing of medicines ,basic laboratory services, vaccination facilities and procedures by a general practitioner or specialist or super-specialist doctor to those in remote or specified areas who have access to little or no medical facilities.

A Mobile clinic is a facility providing general or basic examination, consultation, prescription to outpatients by a General Practitioner(s) or Specialist or Super-specialist Doctor(s) in a mobile vehicle.

44 Scope

44.1 Preventive: Immunization, Antenatal and Postnatal Care.

44.2 Diagnostic: Minimum investigation facilities like Haemoglobin Test, Urine Examination for albumen, sugar and microscopic examination. Diseases like Leprosy, Tuberculosis, and locally endemic diseases to be detected and referred, ECG & Ultrasonography facilities also to be offered in the Mobile unit.

44.3 Curative: Treatment for minor ailments and geriatric cases etc. Appropriate referral of cases for medical specialists etc.

44.4 The Operation of Mobile Clinics is to render Primary Health Care services to those in remote or specified areas who have access to little or no medical facilities.

44.5 The mobile clinics will visit the identified service point to provide health services to the identified community or area.

44.6 To deliver primary service in health education and health promotion.

44.7 To deliver health care services of rehabilitative nature.

44.8 The services offered may also include one or more than one specialty of allopathy medicine, AYUSH, dental, wellness, etc. and allied services like physiotherapy, in the mobile clinic.

44.9 Health records for all patients will be maintained to monitor the program and to facilitate follow-up treatments.

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

44.10 Few minor procedures like dressing and administering Injections etc may be provided in the clinic however not requiring observation or short stay.

45 Infrastructure

45.1 The physical facility shall be developed and maintained to provide safe and secure environment for patients, their families, staff and visitors. It shall be situated in a place having clean surroundings and shall comply with local byelaws in force, if any from time to time.

45.2 The clinic should have a prominent board or signage displaying the name of the clinic in local language at the gate or on the building of the clinic.

45.3 The following other signages shall be well displayed in the language understood by the local public in the area:

a) Name of the doctors with registration number.

b) Services provided within the Facility

46.1 The general practitioner or specialist doctor or super-specialist doctors as per the scope of the clinic or polyclinic shall be registered with State or Central Medical Council of India

46.2 The services provided by the medical professionals shall be in consonance with their qualification, training, registration.

a) Doctor: Allopathic Doctor with minimum MBBS qualification.

b) Pharmacist: With at least Diploma in Pharmacy(Desirable)

c) Staff Nurse: Qualified staff nurse with general nursing.

d) Group D:MaleorFemale

e) Counselor for HIV or AIDS counseling: A nurse who will be given training for counselling and laboratory techniques.(Desirable)

f) Driver: With requisite licenses, registration

46.3 Vehicle Requirements:

46.3.1 The vehicle should accommodate visiting team with all needed equipment and materials.

Human Resource

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

a) Oxygen Cylinder.

b) Drug Storage rack.

46.4 Equipment’s Storage Rack.

46.5 Space for Laboratory Equipments.

46.6 IV infusion facilities.

46.7 A licensed driver with uniform, he should be a non-alcoholic and should be available as & when required.

46.8 Vehicle should be kept clean and tidy and should have a name board on the vehicle.

46.9 Vehicle should be regularly serviced and maintained so as to avoid any break down.

46.10 In case of break down, an alternative vehicle should be arranged for without compromising the services of Mobile Health Clinic.

46.11 Vehicle should be insured and coordinated. Under no circumstances, uninsured vehicle shall be used.

46.12 The clinic or polyclinic shall have essential equipment as per APPENDIX I, and emergency equipment as per APPENDIX 2.

46.13 Other equipment as per the scope of service being practiced shall be available.

46.14 Adequate space for storage of equipment and medicines shall be provided and if available, medicines shall be stored as per manufacturer’s guidelines. The equipment should be of adequate capacity to meet work load requirement.

46.15 All equipment should be in good working condition at all times. Periodic inspection, cleaning, maintenance of equipment should be done.

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

47 Furniture & Fixtures

47.1 The Mobile Health Clinic should have furniture like

a) Examination table

b) Chairs

c) Stools

d) Table

e) Furniture required for storage of drugs, equipments, chemicals etc.

f) Dressing table and Stool.

g) Waste collecting bins, as per Biomedical waste management Rules specifications.

48 Record Maintenance and reporting

48.1 Every Clinical Establishment shall maintain medical records of patients treated by it and health information and statistics in respect of national programmes and furnish the same to the district authorities in form of quarterly reports.

48.2 Copies of all records and statistics shall be kept with the clinical establishment in accordance with CE Act (under Section 12(1) (iii) of CEA 2010) or any other relevant Act in force at the time.

48.3 All clinical establishments shall be responsible for submission of information and statistics in time of emergency or disaster or epidemic situation or as required from time to time by National Council CEA 2010.

49 Basic processes

49.1 Registration: Every patient visiting the clinic shall be registered.

49.2Assessment: Every patient shall undergo assessment, during the course of assessment, the patient findings, medications and investigations should be documented with working diagnosis, legibly in the assessment or OPD prescription with the signature of the consultant or Specialist or super specialist with date and time.

49.3 First Aid: Provision shall be made for providing First Aid. Contact details of ambulance hospital etc shall be available.

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

Appendix 1

Essential Equipments

S. No. 1

16 17

18 19

21 22

Name of the equipment

Stethoscope

Thermometer(Non Mercury)

Torch (flash lights)

Sphygmomanometer(B.P. Apparatus) (Non Mercury)

Weighing machine(Optional)

Autoclave

Stretcher Folding

Oxygen Cylinder with Accessories

Sterilizers

Examination Table

Stool

Artery forceps

Needle Holder

Needles

Cutting Scissor

Dressing Scissor

Dressing Bin

BP Handle

BP Blades

Glues syringes with needles

Disposable syringes kidney tray

Ambu bags

Suction apparatus with accessories

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

Drugs

S.No Name Of Drugs

Appendix- 2

1 All Essential Emergency drugs

2 Antibiotics

3 Analgesics

4 Anti Helminthics

6 Anti Hypertensives

7 Anti diabetics

8 Anti diarrheals

9 Sedatives

10 Anti snake venom

11 Vitamins and other supportive drugs

12 Eye drops

13 Ointments

14 Dressing materials

15 Anti coagulants

16 IV fluids

17 ORS

Anti fungal drugs

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

Clinical Establishments Act

Standard for

Mobile Dental Van Standard No.CEA or Dental Mobile Van

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

DEFINITION

Mobile dental van

SCOPE OF SERVICES PROVIDED

Units may be towed or self-propelled, ranging from smaller, one-chair to two-chair units that can be used for examination, preventive and treatment services.

MOBILE UNITS: Mobile units with more than one chair would generally be recommended for full treatment services

PHYSICAL INFRASTRUCTURE

LOCATION

It is important to consider the size and practicality of the unit needed in relation to the locations it will be required to service. Appropriate access to a suitable site and services (concrete pad, electricity, clean and waste water, data and phone) must be available at each location.

SPACE REQUIREMENT

2. There must be a specific space for cleaning and sterilisation of dental instruments designated as STERILIZATION AREA to accommodate front loading autoclave and lab area to carry out minor prosthetic adjustment with washbasin and running tap water.

3. Dedicated area for storing patient’s records or Electronic Health Record (EHR)maintenance

1. In a self-propelled vehicle, a two-chair program requires a treatment area of a minimum of 18 square feet, plus a cab area of at least 7 square feet–generally a total of around 30 square feet.

OUTSIDE SIGNAGES

1. Name of the dental or medical college or hospital or charitable institute or NGO(to

which the van belongs)

INSIDE SIGNAGES

1. Name of dentist in charge 2. Name of stationed doctors 3. OPD hours

4. Services provided

5. Charges of the services offered

6. Emergency contact number

7. Safety signages: to make the patient aware so as to inform treating doctor of any pre

existing medical conditions

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

INFRASTRUCTURE CONSIDERATIONS

• •

•

• • •

medical gases –oxygen(cylinder)-in case treatment services are being provided floors and walls – these must be non-porous, without carpets, smooth and easily cleaned

lighting – natural or high-intensity colour-corrected artificial lighting

FIXTURES

Dental chair: minimum 2 dental chairs.

specialist fittings (example: overhead light, x- ray unit, dental unit) hand-washing facilities (elbow-touch taps or infra-red)

dental cabinetry and overhead cabinets

bins for general waste, clinical waste and sharps

PERSONAL HYGIENE AND PROTECTION

Hand-washing facilities in every dental surgery are essential, and must not be combined with sinks used for other purposes, such as decontamination and instrument cleaning. Emphasis should be given to the use of hands-free facilities, where possible (eg, elbow or knee operated taps or infra-red-activated operating lights and hand-basin taps).

Procedures must be implemented for the safe handling and appropriate disposal of contaminated materials and waste. Hands-free access to bins for paper and clinical waste is recommended

ACOUSTICS

Compressor should preferably not be kept in the working area

LIGHTING

colour-corrected light or natural

SPECIFIC CONSIDERATIONS OF MOBILE DENTAL VAN

•Chassis: a durable, watertight, reinforced floor is recommended. Insulation should provide the best possible protection from outside temperatures.

• Levelling jacks: there should be one on each corner to provide stability when the unit is stationary.

• Access: there should be at least one door for one –two dental chairs

• Steps: these should be fold-away, lockable when in position, and incorporate a handrail.

• Windows: tinted security windows are best, with insect screens and blinds.

• Services: these will include a compressor, evacuator motor, water inlet, and pump for the base of the dental chair(s).

• Mounting brackets: these are required for lights, the x-ray unit and dental unit.

• Water supply: use a dual system so that town water can be used when available, plus storage tanks top or beneath the vehicle floor (but protected from road damage).

• Water filter: use a filter suitable for use in dental units, and locate this with the water pump.

• Waste disposal: there should be an inbuilt waste water collection unit beneath the floor for collection of the generated waste water. If disposed outside, solid and water waste must comply with territorial local authority and regional council requirements where the unit will be operated.

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

• •

Internal finishes: cabinetry and bench tops must be easily cleaned. Sinks or basins: there should be a minimum of one clean and one dirty.

Equipment: must be properly secured to be protected from road shock and vibration, and wall-mounted x-rays and lights must be secure in-transit. Water and air lines must not leak, on-board power generators cannot make too much noise andoror vibration, and equipment must be properly placed to ensure there is adequate space for dentists and technicians to operate.

HUMAN RESOURCES DOCTORS

1. Dental surgeons(Bachelor in Dental Surgery or Master in Dental Surgery) on full time basis- 1-2 in number

TECHNICAL STAFF

1. Dental operating room assistant

one for a every 2 dental chairs installed qualification: tenth pass

having 5 years working experience under a registered dental surgeon

NON TECHNICAL STAFF

GRADE IV staff employed full time.

Duty roster

Hospital or concerned authority for technical or non-technical staff

Periodic health check up, vaccination of staff

Once in a year health check up of all the staff.

Mandatory hepatitis B vaccination of the staff.

EQUIPMENT (FUNCTIONAL)

1. Stethoscope

2. Thermometer- non mercury based

3. BP apparatus- non mercury based

4. Glucometer

5. Weighing machine

6. Emergency kit and medicine

Oxygen cylinder Adrenaline Diphenhydramine Hydrocortisone Nitroglycerine Salbutamol

Morphine

Diazepamor midazolam Aspirin tablets Ambulatory bag

7. DEFIFIBRILLATOR- either mechanical or automatic

8. Consumables- should be available in adequate

number.

QUANTITY 1

1 1

2 ampoules 2 ampoules 2 ampoules 2 ampoules 2 ampoules 2 ampoules 2 ampoules

1 1

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

Facemask

Gloves: both sterile and non-sterile

Cotton rolls

Gauze

2cc and 5cc syringes with needles

Sutures- vicryl

Silk

Lignocaine 2 percent with 1:200000

Adrenaline and without adrenaline

Zinc oxide powder and eugenol liquid

Glass ionomer (powder and liquid)

Silver based GIC(powder and liquid)

Gum paint

9. DENTAL EQUIPMENT

Dental operating unit

Dental chair

SUCTION UNIT AUTOCLAVE IOPA MACHINE

Either hydraulic or electric; with a back rest in movable trendelenberg or reverse trendelenberg position

Either attached to dental chair or separate; Should have a separate amalgam separation filter

office-based front loading autoclave;

Processing system and design – automation or manual; daylight loader or RVG

IOPA machine should be approved by AERB.

1 Lead apron and thyroid collar or lead shield

Maintenance of logbook mandatory which mentions the identity of the person radiographed, part exposed, date along with operator or doctor’s name and signatures

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

SUPPORT SERVICES

ETHICS

To do no harm (Non- maleficience) Veracity(truthfulness) confidentiality

BMW MANAGEMENT

Segregation of waste should be done in black, yellow and blue bags . It is mandatory to segregate the waste at the site of waste generation.

BLACK BAGS: Kitchen waste

Carry bags

Paper and packaging Disposable glasses or plates Leftover foods

Bouquets

Thermocol

YELLOW BAGS Human tissues

Histopathology specimens

Body parts and organs

Soiled waste swabs, dressing, mops, bandages or items contaminated with blood Microbiology or bio-technology waste

BLUE BAGS

Disinfected catheters

Any other tubings

IV bottles

IV tubes

Disinfected plastic drains

Rubber or latex gloves(mutilated and disinfected) Other plastic material

RED BAGS

Every dental chair installed will have its separate yellow bag. For 2 chairs there will be one black, one red and one blue bag.

There will be one needle destroyer in the mobile van.

Contract for disposal of BMW should be given to a company approved by government of India or Ministry of Environment or CPC.

There should be a written contract for BMW management along with the economy involved.

Logbook should be maintained mentioning weight of the waste (infected) and date on which waste (new or old) was lifted.

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

RECORD MAINTENANCE AND REPORTING

Daily record keeping for incoming patients mentioning patient name, age, sex, date, services rendered along with treatment charges.

MLC

CONFIDENTIALITY

“All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not be spread, I will keep secret and will never reveal”-Hippocratic oath

STANDARDS ON BASIC PROCESSESES

INFECTION CONTROL

1.Instruments sterilization and cleaning must not be executed inside the surgery room.

2.There must be good supply of clean water, through a quality piping that support good water hygiene.

3.All general purpose cleaning equipment and agents should be stored in a separate part of the premises

4.There must be a specific space for cleaning and sterilisation of dental instruments and should not be used other than above.

5.Use trash bin lined with commercial color coded plastic bag for the medical waste inside the surgery room.

6.Needle destroyer must be used for disposable needles

7.Keep cleaning equipment always in a very clean condition before use; type of floor sanitizing and cleaning agents must be approved for clinical use.

8.Hands-free access to bins for paper and clinical waste is recommended

9.Emphasis should be given to the use of hands-free facilities, where possible (eg, elbow or knee operated taps or infra-red-activated operating lights and hand-basin taps).

10.Use of liquid soap (no soap bar)is mandatory

11.There should be no cotton or wool fabric curtains in dental clinics.

12.In door pets and natural plant inside the surgery room should be not permitted 13.Non-wooden storage cabinet shall be used for storing cleaning equipment and agents

14.An infection control protocol should be established to include an exposure control plan based on OSHA’S blood borne pathogen standard. This is a written plan to minimize or eliminate occupational exposure.

15.Personal Protective Equipment(PPE)such as laboratory coats, gowns ,facemask, gloves etc should be utilized.

FACILITIES FOR HAND WASHING

Clinical Establishments Act Standards for Mobile Clinic with Procedures in Local or Regional Anesthesia CEA or Mobile Clinic 002

taps or infra-red-activated operating lights and hand-basin taps). Use of liquid soap (no soap bar) is mandatory.

FACILITIES FOR STERILIZATION

Disinfectants- 2 percent glutaraldehyde, sodium hypochlorite, chlorhexidine etc

Autoclave office-based; maintenance (self-contained with drier); availability of parts; door design; loading system; cylinder size; cycle-reporting system; validation and calibration system

POLICY ON OUTSOURCED SERVICES Lab work can be outsourced

BioMedical Waste management, cleaning staff and pest control are some of the other services which can be outsourced

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

Clinical Establishments Act

Standard for

HOSPITAL (LEVEL 1A &1B) Standard No. CEA /Hospital – 001

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

Table of Contents

Sr. No.

Particulars

Page No.

Categorization of Hospitals

Definition

Scope

Infrastructure

Equipment

Human Resource

Support Services

Legal or Statutory Requirements

Record Maintenance and Reporting

10.

Basic Processes

11.

Appendix 1

12.

Appendix 2

13.

Appendix 3

14.

Appendix 4

15.

Appendix 5

16.

Appendix 6

17.

Appendix 7

18.

Appendix 8

19.

Appendix 9

20.

Appendix 10

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

Categorization of Hospitals

The minimum standards for Allopathic hospitals under Clinical Establishments Act, 2010 have been developed on the basis of level of care provided as defined below:

Hospital Level 1 (A)-

General Medical services with indoor admission facility provided by recognized allopathic medical graduate(s) and may also include general dentistry services provided by recognized BDS graduates.

Example: PHC, Government and Private Hospitals and Nursing Homes run by MBBS Doctors etc.

Hospital Level 1(B) –

This level of hospital shall include all the general medical services provided at level 1(A) above and specialist medical services provided by Doctors from one or more basic specialties namely General Medicine, General Surgery, Paediatrics, Obstetrics & Gynaecology and Dentistry, providing indoor and OPD services.

Level 1(A) and Level 1(B) Hospitals shall also include support systems required for the respective services like Pharmacy, Laboratory, etc.

Example: General Hospital, Single or Multiple basic medical specialties provided at Community Health Centre, Sub Divisional Hospital, and Private Hospital of similar scope, Nursing Home, Civil or District Hospital in few places etc.

Hospital Level 2 (Non-Teaching)

This level may include all the services provided at level 1(A) and 1(B) and services through other medical specialties given as under, in addition to basic medical specialty given under 1(B) like:

a. Orthopaedics

b. ENT

c. Ophthalmology

d. Dentistry

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

e. f. g. h. i. j.

Imaging facility, Operation Theatre etc.

Example: District Hospital, Corporate Hospitals, Referral Hospital, Regional or State Hospital, Nursing Home and Private Hospital of similar scope etc.

Hospital Level 3 (Non-Teaching) Super-specialty services –

This level may include all the services provided at level 1(A), 1(B) and 2 and services of one or more of the super specialty with distinct departments and or also Dentistry if available. It will have other support systems required for services like pharmacy, Laboratory, and Imaging facility, Operation Theatre etc.

Example: Corporate Hospitals, Referral Hospital, Regional or State Hospital, Nursing Home and Private Hospital of similar scope etc.

Hospital Level 4 (Teaching) –

This level will include all the services provided at level 2 and may also have Level 3 facilities. It will however have the distinction of being teaching or training institution and it may or may not have super specialties. Tertiary healthcare services at this level can be provided through specialists and may be super specialists (if available). It will have other support systems required for these services. It shall also include the requirement of Medical Council of India or other registering body for teaching hospitals and will be governed by their rules. However registration of teaching Hospitals will also be required under Clinical Establishments Act for purpose other than those covered under Medical Council of India such as, records maintenance and reporting of information and statistics, and compliance to range of rates for Medical and Surgical procedures, etc.

Emergency with or without ICU Anaesthesia

Psychiatry

Dermatology Pulmonary Medicine

Physical medicine and Rehabilitation, etc.

And support systems required for the above services like Pharmacy, Laboratory,

CEA/Hospital – 001

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

Clinical Establishment Act Standards for Hospital (LEVEL 1A 1B)

1. Definition

A hospital is a clinical establishment providing patient treatment by qualified and trained staff and equipment through Allopathy – Modern system of medicine; where the patients are ‘admitted’ and stay overnight or more and they are referred as ‘inpatients’; while some patients may go to a hospital just for diagnosis, treatment, or therapy and then leave, they are referred as ‘outpatients’ without staying overnight.

Hospitals have facility to admit and care for inpatients whilst the other clinical establishments are described as clinics or polyclinics or day care centres. There are other exceptions too like Hospice etc.

The general hospital, may have multiple departments taking care of many kinds of disease and Injury, and normally has an emergency department to deal with immediate and urgent care.

Specialized hospitals may include trauma centres, rehabilitation hospitals, children’s hospitals, Mental hospitals or, and hospitals for dealing with specific medical needs such as psychiatric problems (psychiatric hospital) or Sanatorium, certain disease categories such as neurology, cardiology, oncology, or orthopaedic, IVF and so forth.

Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Guidelines laid down by MCI or other legal bodies shall be applicable to such hospitals. The minimum standards will not apply to them.

A hospital can be situated in rural or urban setting. It can be run by Public Sector (Central government or State government or Local government or Public Sector undertaking or Registered Society etc) or by Private Sector (Individual Proprietorship or Registered Partnership or Registered Company or Co-operative Society or Trust or Charitable etc).

Hospital Level 1 (A)-

General Medical services with indoor admission facility provided by recognised allopathic medical graduate(s) and may also include general dentistry services provided by recognized BDS graduates.

Example: PHC, Government and Private Hospitals and Nursing Homes run by MBBS Doctors etc.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

all of the

2.1. 2.2. 2.3. 2.4. 2.5. 2.6.

following specialities:

General Medicine

Obstetrics & Gynaecology (Non-surgical)

Paediatrics

Community Health and Family Medicine

General Dentistry

Basic Support services

Registration or help desk and billing

Diagnostic Services:(Can be own or outsourced or Tie up)

Collection centre or Laboratory X-ray

UltraSonoGraphy

Waste Management Services (General and Biomedical)

3. Infrastructure

a) b)

CEA/Hospital – 001

Hospital Level 1(B) –

Level 1(A) and Level 1(B) Hospitals shall also include support systems required for the respective services like Pharmacy, Laboratory, etc.

Example: General Hospital, Single or Multiple basic medical Specialties provided at Community Health Centre, Sub Divisional Hospital, and Private Hospital of similar scope, Nursing Home, Civil or District Hospital in few places etc.

2. Scope

The scope of services that may be provided at a hospital(level 1A &1B) practising Allopathy – Modern system of Medicine may include patient-care services in any or

3.1

Signage

3.1.1

The Hospital shall display appropriate signage which shall be in at least two

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

languages

The building shall have a board displaying the name of the hospital at a prominent location.

Directional signage shall be placed within the facility to guide the patient(s).

3.1.2

3.1.3

Following informative signage shall be displayed:

3.1.4 3.1.5 3.1.6

3.1.7 3.1.8 3.1.9

Following safety signage shall be displayed: 3.1.11

3.1.12 3.1.13 3.2. 3.2.1

3.2.2

3.2.3 3.2.4

3.2.5 3.2.6

4. Medical Equipment and Instruments:

Name of the care provider with registration number.

Registration details of the hospital as applicable.

Availability of fee structure of the various services provided (refer to Clinical Establishments Act 2010 rules & regulation).

Timings of the facility and services provided.

Mandatory information such as under PNDT Act etc.

Important contact numbers such as Blood Banks, Fire Department, Police and Ambulance Services available in the nearby area.

Safety Hazard and Caution signs, for e.g. hazards from electrical shock, inflammable articles, radiation etc shall be displayed at appropriate places, and as applicable under law.

Appropriate Fire exit signage.

Signage for “No Smoking” at prominent places.

Other requirements

Access to the hospital shall be comfortable for the patient and or attendants or visitors.

Access shall be provided within the requirements of “Persons with Disabilities Act” and shall be easy for all those whose mobility may be restricted due to whatever cause.

The hospital shall be developed and maintained to provide safe, clean and hygienic environment for patients, their attendants, staff and visitors

The hospital shall have 24hr provision of potable water for drinking & hand hygiene. It shall also have 24 hr supply of electricity, either through direct supply or from other sources.

The hospital shall have clean public toilet(s).

Furniture and fixtures shall be available in accordance with the activities and workload of the hospital. They shall be functional and properly maintained.

The minimum space requirements shall be as per Appendix 1

Indicative list of furniture and fixtures is as per Appendix 2

4.1

The hospital shall have adequate medical equipment and instruments, commensurate to the scope of service and number of beds.

4.2

There shall be established system for maintenance of critical equipment.

4.3

Equipment shall be kept in good working condition through a process of periodic inspection, cleaning and maintenance. Annual maintenance.

For indicative list of medical equipment and instruments, Please refer to

Appendix 3.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

5. Drugs, Medical devices and Consumables:

5.1

The hospital shall have adequate drugs, medical devices and consumables commensurate to its scope of services and number of beds.

5.2

Emergency drugs and consumables shall be available at all times.

5.3

Drug storage shall be in a clean, well lit, and safe environment and shall be in consonance with applicable laws and regulations.

5.4

The facility shall have defined procedures for storage, inventory management and dispensing of drugs in pharmacy and patient care areas.

For indicative list of drugs, medical devices and consumables please refer to

Appendix4.

6. Human Resource Requirement

6.1

The hospital shall have qualified and or trained medical and nursing staff as per the scope of service provided and the medical or nursing care.

6.2

The support or paramedical staff shall be qualified and or trained as per the scope of services provided, and as per requirement

6.3

For every staff (including contractual staff), there shall be personal record containing the appointment order, documentary evidence of qualification and or training (and professional registration where applicable).

For human resource requirements please refer to Appendix5.

7. Support Services:

7.1

The Hospital shall have a Registration or Help-desk & Billing counter.

7.2

The diagnostic services, whether in house or outsourced, shall be

commensurate with the scope of service of the hospital.

7.3

Segregation, collection, transportation, storage and disposal of general waste shall be done as per applicable local laws

7.4

Segregation, collection, transportation, storage and disposal of biomedical waste shall be done as per Bio medical waste handling rules.

7.5

The Hospital shall arrange transportation of patients for transfer or referral or investigations etc. in safe manner.

8. Legal or Statutory Requirements

9. Record Maintenance and reporting:

8.1

Compliance with local regulations and law.

Indicative list of legal requirement is as per Appendix 6.

9.1.

The minimum medical records to be maintained and nature of information to be provided by the Hospitals shall be as prescribed by the Clinical Establishment Act

9.2.

Medical Records shall be maintained in physical or digital format.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

9.3.

The hospital shall ensure confidentiality, security and integrity of records.

9.4.

The medical records of IPD patients shall be maintained in consonance with National or local law, MCI guidelines, and court orders.

9.5.

The Hospital shall maintain health information and statistics in respect of national programmes, notifiable diseases and emergencies or disasters or epidemics and furnish the same to the district authorities in the prescribed formats and frequency.

For content of medical record refer to Appendix7

10.Basic Processes

10.1.

The hospital shall register all patients who visit the hospital except if the required service is not available in the facility, in which case the patient is guided to the appropriate nearest facility.

10.2.

Patient shall be guided and informed regarding Patients’ rights & responsibilities, cost estimates, third party services (e.g. Insurance) etc. Appendix 8.

10.3.

The billing shall be as per the Hospital tariff list, which shall be available to patients in a suitable format.

10.4.

Each patient shall undergo an initial assessment by qualified and or trained personnel.

10.5.

Further management of patient shall be done by a registered medical practitioner on the basis of findings of initial assessment; for example, OPD treatment, admission, transfer or referral, investigation etc.

10.6.

The hospital shall ensure adequate and proper spacing in the patient care area so as to prevent transmission of infections.

10.7.

Regular cleaning of all areas with disinfectant shall be done .

10.8.

Housekeeping or sanitary services shall ensure appropriate hygiene and sanitation in the establishment.

10.9.

At the time of admission of patient, general consent for admission shall be taken.

10.10.

In case of non-availability of beds or where clinical need warrants, the patient shall be referred to another facility along with the required clinical information or notes.

10.11.

Reassessments of the admitted patients shall be done at least once in a day and or according to the clinical needs and these shall be documented.

10.12.

Any examination, treatment or management of female patient shall be done in the presence of an employed female attendant or female nursing staff, if conducted by male personnel inside the hospital and vice versa

10.13.

The patient and family shall be treated with dignity, courtesy and politeness.

10.14.

The Hospital shall provide care of patient as per Standard Treatment Guidelines that may be notified by the Central or State Government (Desirable)

10.15.

The Clinical Establishment shall undertake to provide within the staff and facilities available, such medical examination and treatment as may be required to stabilize the emergency medical condition of any individual who comes or is brought to such clinical establishment.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

10.16.

Prescription shall include name of the patient, date, name of medication, dosage, route, frequency, duration, name, signature and registration number of the medical practitioner in legible writing.

10.17.

Drug allergies shall be ascertained before prescribing and administration; if any allergy is discovered, the same shall be communicated to the patient and recorded in the case sheet as well.

10.18.

Patient identity, medication, dose, route, timing, expiry date shall be verified prior to administration of medication.

10.19.

Patients shall be monitored after medication administration and adverse drug reaction or events if any shall be recorded and reported.

10.20.

The hospital shall follow standard precautions like practicing hand hygiene, use of personal protection equipment etc. so as to reduce the risk of healthcare associated infections.

10.21.

Security and safety of patients, staff, visitors and relatives shall be ensured by provision of appropriate safety installations and adoption of appropriate safety measures.

10.22.

The patient and or family members are explained about the disease condition, proposed care, including the risks, alternatives and benefits. They shall be informed on the expected cost of the treatment. They shall also be informed about the progress and any change of condition.

10.23.

Informed consent shall be obtained from the patient or next of kin or legal guardian as and when required as per the prevailing Guidelines or Rules and regulations in the language patient can understand (for e.g. before Invasive procedures, Blood transfusion, HIV testing, etc.).Appendix 9

10.24.

10.25.

A Discharge summary shall be given to all patients discharged from the

hospital.

Discharge or Death summary shall also be given to patient and or attendant in case of transfer or Leaving Against Medical Advice or Discharge Against Medical Advice or death

10.26.

The discharge summary shall include the points as mentioned in the Appendix in an understandable language and format. For content of discharge summary refer to Appendix 10.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

APPENDIX 1

Minimum space requirements in a hospital level 1 shall be as follows:

Area (Desirable)

Wards

Ward bed and surrounding space

6sqmor bed; in addition circulation space of 30% as indicated in total area shall be provided for Nursing station, Ward store, Sanitary etc

Minor Operation Theatre or Procedure room

OT for minor procedures (where applicable)

10.5sqm

Labour room

Labour Table and surrounding space

10.5 sqm for labour table

Other areas- nursing station, doctors’ duty room, store, Clean and dirty utility, Circulating area, Toilets

10.5 sqm for clean utility and store and 7 sqm for dirty utility and 3.5 sqm for toilet

Bio-medical Waste

5 sqm

Other functional areas( laboratory, diagnostics, front office or reception, waiting area, administrative area etc.) should be appropriately sized as per the scope of service and patient load of the hospital

Other requirements:

Wards:

1. The ward shall also have designated areas for nursing station, doctors’ duty room, store, clean and dirty utility, janitor room, toilets and this shall be provided from circulation area.

2. For a general ward of 12 beds, a minimum of 1working counter and 1 hand wash basin shall be provided.

3. Distance between beds shall be 1.0 metres.

4. Space at the head end of bed shall be 0.25 metres.

5. Door width shall be 1.2 metres and corridor width 2.5 metres

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

Labour room:

1. The obstetrical unit shall provide privacy, prevent unrelated traffic through the unit and provide reasonable protection of mothers from infection and from cross-infection.

2. Measures shall be in place to ensure safety and security of neonates.

3. Resuscitation facilities for neonates shall be provided within the obstetrical unit and convenient to the delivery room.

4. The labour room shall contain facilities for medication, hand washing, charting, and storage for supplies and equipment.

5. The labour room shall be equipped with oxygen and suction

Emergency room(if available)

1. Emergency bed and surrounding space shall have minimum 10.5 sq m or bed area.

CEA/Hospital – 001

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

APPENDIX 2

FURNITURE AND FIXTURES

S.N 2.

3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.

ARTICLES

Examination Table Writing tables Chairs

Almirah

Waiting Benches

Medical or Surgical Beds

Labour Table- if applicable

Wheel Chair or Stretcher

Medicine Trolley, Instrument Trolley Screens or curtains

Foot Step

Bed Side Table

Baby Cot- if applicable

Stool

Medicine Chest

Examination Lamp

View box

Fans

Tube Light or lighting fixtures

Wash Basin

IV Stand

Colour coded bins for BMW

*This is an indicative list and the items shall be provided as per the size of the hospital and scope of service.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

APPENDIX 3

EQUIPMENT

a. EMERGENCY EQUIPMENT

S. No.

Name of Emergency Equipment

Resuscitation equipment including Laryngoscope, endotracheal tubes, suction equipment, xylocaine spray, oropharyngeal and nasopharyngeal airways, Ambu Bag- Adult &Paediatric (neonatal if indicated)

Oxygen cylinders with flow meteror tubing or catheteror face mask or nasal prongs

Suction Apparatus

Defibrillator with accessories (Desirable)

Equipment for dressingorbandagingorsuturing

Basic diagnostic equipment- Non mercury Blood Pressure Apparatus, Stethoscope, weighing machine, thermometer (Non mercury)

ECG Machine

Pulse Oximeter (Desirable)

Nebulizer with accessories

b. Other equipment and consumables, which shall also be available in good working condition as per the scope of services and bed strength (some of the emergency equipment are already mentioned above).

Department

Equipment

Level 1A

Level 1B

Level 2

Level 3

NON MEDICAL

Administration

Office equipment

Yes

Office furniture

Yes

Electricity

Emergency lights

Yes

Water Supply

Hand-washing sinksortapsorbowls on stands in all areas

Yes

Storage tank

Yes

Water purification

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

Sharps containers in all treatment areas

Food refrigeration

Plates, cups & cutlery

Yes

CEA/Hospital – 001

chemicals or filter

Water source for drinking water

Yes

Waste Disposal

Yes Yes

Yes

Yes Yes

Yes

Yes Yes

Yes

Yes Yes Yes

Yes Yes

Yes

Buckets for contaminated waste in all treatment areas

Yes

Drainage system

Rubbish bins in all

Yes

rooms

Sanitation facilities for patients

Yes

Separate Bio-medical waste disposal

Yes

Safety Vehicle(OwnorOutsourced)

Medical Stores Kitchen(OwnorOutsourced)

Laundry(OwnorOutsourced)

Housekeeping(OwnorOutsourced)

Fire extinguisher

Yes

Vehicle

4 wheeler

Desirable

Yes

Ambulance

Yes

Lockable storage

Yes

Refrigeration

Yes

Cooking pots and utensils

Yes

Cooking stove

Yes

Storage

Yes

Washing and drying area facilities

Yes

Detergentorsoap

Washing and rinsing equipmentorbowls

Housekeeping Brooms, brushes and mops

Yes

Buckets

Yes

Soap and

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

Yes

CEA/Hospital – 001

disinfectant

MEDICAL

Outpatient Rooms

Non Mercury Blood Pressure Apparatus and stethoscope

Container for sharps disposal

Yes

Desk and chairs

Yes

Examination gloves

Yes

Examination table

Yes

Hand washing facilities

Yes

Light source

Yes

Minor surgical instruments

Yes

Ophthalmoscope

Otoscope

Patellar hammer

Receptacle for soiled pads, dressings, etc.

Yes

Separate biohazard disposal

Yes

Sterile equipment storage

Yes

Sutures

Yes

Thermometer(Non mercury)

Yes

Torch with extra batteries

Weighing scale

Yes

Women and Child health examination room

Yes Yes

Yes (as Yes applicable)

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes

Yes Yes Yes Yes

Yes Yes Yes

Yes Yes

Non Mercury Blood Pressure Apparatus and stethoscope

Yes

Contraceptive supplies

Yes

Birth register

Examination gloves

Examination table with stirrups

Yes

Fetal stethoscope

Yes

Doppler

Hand washing facility

Yes

Height measure

Yes

IUD insertion set

Yes

Pregnant woman Register

Yes

Speculum and vaginal examination kit

Yes

Syringes and needles

Tape measure

Yes

Tococardiograph

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

Labour room

Baby scales Yes Yes Non Mercury Blood Yes Yes

Pressure Apparatus and

stethoscope

Clean delivery kits and Yes Yes

cord ties

Curtains if more Yes Yes Yes Yes than one bed

Delivery bed and bed Yes Yes

linen

Fetal stethoscope Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes

Hand washing facility Yes Yes

Instrument trolley Yes Yes Yes Yes

Yes Yes

IV treatment sets Yes Yes

Latex gloves and Yes Yes Yes Yes protective clothing

Linens for newborns Yes Yes

Mucus extractor Yes Yes Yes Yes

Yes Yes

Oral airways, various Yes Yes

sizes

Oxygen cylinder Yes Yes Yes Yes orconcentrator

Partograph charts Yes Yes

Self inflating bag and Yes Yes

mask – adult and

neonatal size

Suction machine Yes Yes

Suturing sets Yes Yes Yes Yes

Thermometer(Non Yes Yes mercury)

Tray with routine & Yes Yes emergency drugs,

syringes and needles

Urinary catheters and Yes Yes

collection bags

Vacuum extractor set Yes Yes Yes Yes

Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes

Work surface near bed Yes Yes for newborn

resuscitation

Yes Yes Yes Yes

Inpatient Wards

Basic examination Yes Yes equipment

(stethoscope, Non

mercury BP Apparatus

(etc)

Yes Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

Beds, washable mattresses and linen

Yes

Curtains

Yes

Dressing sets

Yes

Dressing trolleyorMedicine trolley

Yes

Gloves

Yes

IV stands

Yes

Medicine storage cabinet

Yes

Oxygen cylinder and concentrator

Yes

Patient trolley on wheels

Yes

PPE kits

Yes

Suction machine

Yes

Urinals and bedpans

Yes

OperationTheatre : If available

Yes

Yes Yes Yes

Yes Yes

Yes Yes Yes

Yes Yes

Yes Yes Yes

Yes Yes

Yes (as applicable )

Yes

Adequate storage

Ambu resuscitation set with adult and child masks

Yes

Defibrillator

Yes

Electro cautery

Yes

Fixed operating lights

Laryngoscope set

Fixed suction machine

Hand washing facilities

Yes

Instrument tray

Yes

Instrument trolley

Yes

Mayo Stand

Mobile operating light

Oral airways, various sizes

Oxygen cylinder and concentrator

Patient trolley on wheels

Yes

Ophthalmic Operating Microscope

Yes (as applicabl e)

Yes

Portable suction machine

Yes

Safety Box

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

Sphygmomanometer Yes Yes

(Non Mercury) and

stethoscope

Stool adjustable height No Yes Yes Yes

Yes Yes

Operating table No Yes IV Therapy Equipment No

Anesthesia Equipment No Yes Anesthetic

trolleyormachine

O2 Monitor No

Endoscopic equipment No No

and necessary

accessories

Bronchoscope No No

Colonoscope No No Desirable Yes

Yes Yes Yes Yes

CO2 Monitor

Yes

Yes Yes No Yes

Desirable Yes

Endoscope No No

Fiber Optic No No Desirable Yes Laryngoscope

Central Supply

Amputation set No No No Yes

Desirable Yes

Caesareanorhysterecto No No my set

Dilatation and No No curettage set

Yes Yes Yes Yes No Yes

Endoscopic instrument No No

cleaning machines

and solutions

Hernia set No No Yes Yes

Laparotomy set No No

Linens Yes Yes Yes Yes

Yes Yes

Locked storage Yes Yes

Operating drapes No Yes Yes Yes

Yes Yes

Ophthalmic instrument No No

Protective caps, aprons, Yes Yes Yes Yes shoes and gowns etc.

Pelvicorfistula repair No No

set

Yes Yes No Yes Yes Yes

No Yes

Sterile gloves

Yes

Sterilization equipment Yes Yes for instrument and

linens

Thoracocentesis set No No

Surgical supplies (e.g., sutures, dressings, etc.)

Yes

Thoracostomy set with

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

appropriate tubes and water sealbottles

Thoracotomy set

Yes

ThyroidorParathyroid set

Yes

Tracheostomy set

Yes

Tubal ligationset

Yes

Vascular repair set

Yes

Other equipment as per the specialized services available shall also be there

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

a. List of Emergency Drugs and consumables (Essential in all hospitals)

Sl. No.

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

22. 23.

APPENDIX 4

DRUGS, MEDICAL DEVICES AND CONSUMABLES

Name of the Drug

INJECTIONECTIONS

Injection. Diazepam 10 Mg Injection. Frusemide 20 Mg Injection. Ondansetron 8 Mgor4ml Injection. Ranitidine

Injection Nor Adrenaline 4 Mg Injection. Phenytoin 50 Mg Injection Diclofenac 75 Mg Injection. Deriphylline

Injection Chlorpheniramine Maleate Injection. Hydrocortisone 100 Mg Injection. Atropine 0.6 Mg

Injection. Adrenaline 1 Mg Injection. Kcl

Sterile Water

Injection. Soda Bicarbonate Injection. Dopamine Injection. Nalaxone 400 Mcg Injection. Lignocaine 50 Ml Tab. Sorbitrate

Tab. Aspirin

Injection. Tetanus Other

Neb. Salbutamol2.5 Ml Neb. Budesonide

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

24.

Lignocaine Jelly 2%

25.

Activated Charcoal

26.

Calcium (Injection Or Tab)

Fluids

27.

RL 500 Ml

28.

NS 500 Ml

29.

NS 250 Ml

30.

NS 100 Ml

31.

DNS 500 Ml

32.

Dextrose 5% 500 Ml

33.

Dextrose 10% 500 Ml

34.

Pediatric Iv Infusion Solution 500 Ml

b. The other drugs and consumables shall be available as per the scope of services, bed strength and patient turnover.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

APPENDIX 5

HUMAN RESOURCE

The Human Resource requirement for any hospital depends on the scope of services provided by the hospitals, bed strength and workload of the hospital.

However on the basis of level of care provided the minimum staffing requirements for Hospital level 1 shall be as follows:

CEA/Hospital – 001

Doctor

Qualified doctor shall be available round the clock on site. Level 1A shall have a MBBS qualified doctor.

(Qualified doctor is a MBBS approved as per state government rules & regulations as applicable from time to time).

Level 1B shall have MBBS doctor with required post-graduation qualification.

Nurses

Qualified nurses per unit per shift shall be available as per requirement laid down by“The Indian Nursing Council, 1985”, occupancy rate and distribution of bed.

Pharmacist (If in house pharmacy available)

1 in a hospital

Lab Technician (if in house laboratory service available)

1 in a hospital (minimum DMLT) BSc, MSc ,MLT(Desirable)

X-ray Technician (if in house X-ray facility available)

1 in a hospital (minimum Diploma in X Ray Technician course)

Multi Task staff

Minimum 1

Requirement of other staff (Support and administrative) will depend on the scope of the hospital.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

APPENDIX 6

LIST OF LEGAL REQUIREMENTS

Below is the list of legal requirements to be complied with by a hospital as applicable by the localorstate health authority (all may not be applicable):

CEA/Hospital – 001

Sn Name of Document

1 Registration under Nursing Home Actor Medical Establishment Act

2 Bio-medical Waste Management Licenses Authorization of HCO by PCB

MOU with Vendor

3 AERB Licenses

4 NOC from Fire Department

5 Ambulance

Commercial Vehicle Permit Commercial Driver License Pollution Control Licenses

6 Building Completion Licenses

7 Lift license for each lift

8 DG Set Approval for Commissioning

9 Diesel Storage Licenses

10 Retail and bulk drug license (pharmacy)

11 Food Safety Licenses

12 Narcotic Drug Licenses

13 Medical Gases Licensesor Explosives Act

14 Clinical Establishments and Registration (if

applicable)

15 Blood Bank Licenses

16 MoU or agreement with outsourced human resource agencies as per labor laws

17 Spirit License

18 Electricity rules

19 Provident fundorESI Act

21 PC PNDT Act

23 PAN

25 Arms Act, 1950 (if guards have weapons)

Valid Vali From d

Send for

Remark

(Expiredo r validorN A)

renewal Till by

MTP Act

Sales Tax registration

No objection certificate under Pollution Control Act (AirorWater)

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

APPENDIX 7

CONTENT OF MEDICAL RECORD

Medical record shall contain, at the least, the following information:

CEA/Hospital – 001

S. No.

Content

Name & Registration number of treating doctor

Name, demographic details & contact number of patient

Relevant Clinical history, Assessment and re-assessment findings, nursing notes and Diagnosis

Investigation reports

Details of medical treatment, invasive procedures, surgery and other care provided

Applicable consents

Discharge summary

Cause-of-death certificate & Death Summary (where applicable)

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

APPENDIX 8 Patients’ rights and responsibilities:

A patient and hisorher representative has the following rights with respect to the clinical establishment-

41. To adequate relevant information about the nature, cause of illness, proposed investigations and care, expected results of treatment, possible complications and expected costs;

42. Rate of services provided by the clinical establishment would be displayed prominently.

43. To access a copy of case papers, patient records, investigations reports and detailed bill.

44. To informed consent priorto specific testsortreatment (e.g. surgery, chemotherapy)

45. To seek second opinion from an appropriate clinician of patients’ choice, with records and information being provided by treating hospital

46. To confidentiality, human dignity and privacy during treatment.

47. To have ensured presence of a female person, during physical examination of

a female patient by a male practitioner.

48. To non-discrimination about treatment and behaviour on the basis of HIV

status

49. To choose alternative treatment if options are available

50. Rate of services provided by the clinical establishment would be displayed

prominently.

Provide all health related information

Cooperate with Doctors during examination, treatment

Follow all instructions

Pay hospitals agreed fees on time

Respect dignity of doctors and other hospital staff

Never resort to violence

Patients’ Rights

Patients’ Responsibilities

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEA/Hospital – 001

APPENDIX 9

INFORMED CONSENTorCONSENT GUIDELINES

The informed consent shall at the least contain the following information in an understandable language and format (desirably which a lay person can easily understand)

Sl. No.

Content

Name of the patientor guardian (in case of minorormentally disabled).

Registration number of patient

Date of admission

Name & Registration number of treating doctor

Name of procedureoroperationorinvestigationorblood transfusionoranaesthesia and potential complications should be explained

Signature of patientorguardian with date and time

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

APPENDIX 10

DISCHARGE SUMMARY

The discharge summary shall at the least contain the following information in any understandable language and format:

CEA/Hospital – 001

Sl.no.

Content

Name & Registration number of treating doctor

Name, demographic details & contact number of patient, if available

Date of admission and discharge

Relevant clinical history, assessment findings and diagnosis

Investigation results,

Details of medical treatment, invasive procedures, surgery and other care provided

Discharge advice (medications and other instructions).

Instruction about when and how to obtain urgent care.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Clinical Establishments Act

Standard for

HOSPITAL (LEVEL 1A &1B) Standard No. CEA orHospital – 001

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Table of Contents

Sr. No.

Particulars

Page No.

Categorization of Hospitals

Definition

Scope

Infrastructure

18.

Equipments

19.

Human Resource

20.

Support Services

21.

LegalorStatutory Requirements

22.

Record Maintenance and Reporting

23.

Basic Processes

24.

Appendix 1

25.

Appendix 2

26.

Appendix 3

27.

Appendix 4

28.

Appendix 5

29.

Appendix 6

30.

Appendix 7

18.

Appendix 8

19.

Appendix 9

20.

Appendix 10

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Categorization of Hospitals

The minimum standards for Allopathic hospitals under Clinical Establishments Act, 2010 are developed on the basis of level of care provided, as defined below:

Hospital Level 1 (A)-

General Medical services with indoor admission facility provided by recognized allopathic medical graduate(s) and may also include general dentistry services provided by recognized BDS graduates.

Example: PHC, Government and Private Hospitals and Nursing Homes run by MBBS Doctors etc.

Hospital Level 1(B) –

This level of hospital shall include all the general medical services provided at level 1(A) above and specialist medical services provided by doctors from one or more basic specialties namely General Medicine, General Surgery, Paediatrics, Obstetrics & Gynaecology and Dentistry, providing indoor and OPD services.

Level 1(A) and Level 1(B) Hospitals shall also include support systems required for the respective services like Pharmacy, Laboratory, etc.

Example: General Hospital, Singleor Multiple basic medical Specialties provided at Community Health Centre, Sub Divisional Hospital, and Private Hospital of similar scope, Nursing Home, Civil or District Hospital in few places etc.

Hospital Level 2 (Non-Teaching)

This level may include all the services provided at level 1(A) and 1(B) and services through other medical specialties given as under ,in addition to basic medical specialty given under 1(B) like:

k. l. m. n.

Orthopaedics ENT

Ophthalmology Dental

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

o. Emergency with or without ICU

p. Anaesthesia

q. Psychiatry

r. Skin

s. Pulmonary Medicine

t. Rehabilitation, etc.

And support systems required for the above services like Pharmacy, Laboratory, Imaging facilities, Operation Theatre etc.

Example: District Hospital, Corporate Hospitals, Referral Hospital, Regionalor State Hospital, Nursing Home and Private Hospital of similar scope etc.

Hospital Level 3 (Non-Teaching) Super-specialty services –

This level may include all the services provided at level 1(A), 1(B) and 2 and services of one or more of the super specialty with distinct departments andoror also Dentistry if available. It will have other support systems required for services like pharmacy, Laboratory, and Imaging facility, Operation Theatre etc.

Example: Corporate Hospitals, Referral Hospital, RegionalorState Hospital, Nursing Home and Private Hospital of similar scope etc.

Hospital Level 4 (Teaching) –

This level will include all the services provided at level 2 and may also have Level 3 facilities. It will however have the distinction of being teaching or training institution and it may or may not have super specialties. Tertiary healthcare services at this level can be provided through specialists and may be super specialists (if available). It will have other support systems required for these services. It shall also include the requirement of MCIorother registering body for teaching hospitals and will be governed by their rules. However registration of teaching Hospitals will also be required under Clinical Establishment Act for purpose other than those covered under MCI such as, records maintenance and reporting of information and statistics, and compliance to range of rates for Medical and Surgical procedures, etc.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Clinical Establishment Act Standards for Hospital (LEVEL 1A 1B)

11. Definition

Hospitals have facility to admit and care for inpatients whilst the other clinical establishments are described as clinicsorpolyclinics or day care centres. There are other exceptions too like Hospice etc.

The general hospital, may have multiple departments taking care of many kinds of disease and Injectionury, and normally has an emergency department to deal with immediate and urgent care.

A hospital can be situated in rural or urban setting. It can be run by Public Sector (Central governmentorState governmentorLocal governmentorPublic Sector undertakingorRegistered Society etc) or by Private Sector (Individual Proprietorshipor Registered PartnershiporRegistered Company orCo-operative SocietyorTrust orCharitable etc).

Hospital Level 1 (A)-

General Medical services with indoor admission facility provided by recognised allopathic medical graduate(s) and may also include general dentistry services provided by recognized BDS graduates.

Example: PHC, Government and Private Hospitals and Nursing Homes run by MBBS Doctors etc.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

all of the

2.7. 2.8. 2.9. 2.10. 2.11. 2.12.

d) e)

following specialities:

General Medicine

Obstetrics & Gynaecology (Non-surgical)

Paediatrics

Community Health and Family Medicine

General Dentistry

Basic Support services

Registration or help desk and billing

Diagnostic Services:(Can be ownoroutsourcedorTie up)

Collection centreorLaboratory X-ray

USG

Waste Management Services (General and Biomedical)

13. Infrastructure

CEAorHospital – 001

Hospital Level 1(B) –

This level of hospital shall include all the general medical services provided at level 1(A) above and specialist medical services provided by Doctors from one or more basic specialties namely General Medicine, General Surgery, Paediatrics, Obstetrics &Gynaecology and Dentistry, providing indoor and OPD services.

Level 1(A) and Level 1(B) Hospitals shall also include support systems required for the respective services like Pharmacy, Laboratory, etc.

Example: General Hospital, Singleor Multiple basic medical Specialties provided at Community Health Centre, Sub Divisional Hospital, and Private Hospital of similar scope, Nursing Home, Civil or District Hospital in few places etc.

12. Scope

The scope of services that may be provided at a hospital(level 1A &1B) practising Allopathy – Modern system of Medicine may include patient-care services in any or

3.1

Signage

3.1.1

The Hospital shall display appropriate signage which shall be in at least two languages.

A board stating “24 hours emergency available” is desirable.

3.1.2

The building shall have a board displaying the name of the hospital at a prominent location.

3.1.3

Directional signage shall be placed within the facility to guide the patient(s).

The directional signages should be permitted outside in the nearby vicinity of

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

Important contact numbers such as Blood Banks, Fire Department, Police and Ambulance Services available in the nearby area.

CEAorHospital – 001

the hospitalorNursing Home to facilitate easy access

Following informative signage shall be displayed:

3.1.4 3.1.5 3.1.6

3.1.7 3.1.8 3.1.9

Following safety signage shall be displayed: 3.1.11

3.1.12 3.1.13 3.2. 3.2.1

3.2.2

3.2.3 3.2.4

3.2.5 3.2.6

14. Medical Equipment and Instruments:

Name of the care provider with registration number.

Registration details of the hospital as applicable.

Availability of fee structure of the various services provided (refer to CEA 2010 rules & regulation).

Timings of the facility and services provided.

Mandatory information such as under PNDT Act etc.

Safety Hazard and Caution signs, for e.g. hazards from electrical shock, inflammable articles, radiation etc shall be displayed at appropriate places, and as applicable under law.

Appropriate Fire exit signage.

Signage for “No Smoking” at prominent places.

Other requirements

Access to the hospital shall be comfortable for the patient andoror attendantsorvisitors.

Access shall be provided within the requirements of “Persons with Disabilities Act” and shall be easy for all those whose mobility may be restricted due to whatever cause.

The hospital shall be developed and maintained to provide safe, clean and hygienic environment for patients, their attendants, staff and visitors

The hospital shall have 24hr provision of potable water for drinking & hand hygiene. It shall also have 24 hr supply of electricity, either through direct supply or from other sources.

The hospital shall have clean public toilet(s).

Furniture and fixtures shall be available in accordance with the activities and workload of the hospital. They shall be functional and properly maintained.

The minimum space requirements shall be as per Appendix 1

Indicative list of furniture and fixtures is as per Appendix 2

4.1

The hospital shall have adequate medical equipment and instruments, commensurate to the scope of service and number of beds.

4.2

There shall be established system for maintenance of critical equipment.

4.3

Equipment shall be kept in good working condition through a process of periodic inspection, cleaning and maintenance. Annual maintenance.

For indicative list of medical equipment and instruments, Please refer to

Appendix 3.

15. Drugs, Medical devices and Consumables:

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

17.Support Services:

CEAorHospital – 001

5.1

The hospital shall have adequate drugs, medical devices and consumables commensurate to its scope of services and number of beds.

5.2

Emergency drugs and consumables shall be available at all times.

5.3

Drug storage shall be in a clean, well lit, and safe environment and shall be in consonance with applicable laws and regulations.

5.4

The facility shall have defined procedures for storage, inventory management and dispensing of drugs in pharmacy and patient care areas.

For indicative list of drugs, medical devices and consumables please refer to

Appendix4.

16.Human Resource Requirement

6.1

The hospital shall have qualified andoror trained medical and nursing staff as per the scope of service provided and the medicalornursing care.

6.2

The supportorparamedical staff shall be qualified andoror trained as per the scope of services provided, and as per requirement

6.3

For every staff (including contractual staff), there shall be personal record containing the appointment order, documentary evidence of qualification andoror training (and professional registration where applicable).

For human resource requirements please refer to Appendix5.

7.1

The Hospital shall have a Registrationor Help-desk & Billing counter.

7.2

The diagnostic services, whether in house or outsourced, shall be commensurate with the scope of service of the hospital.

7.3

Segregation, collection, transportation, storage and disposal of general waste shall be done as per applicable local laws

7.4

7.5

Segregation, collection, transportation, storage and disposal of biomedical waste shall be done as per Bio medical waste handling rules.

The Hospital shall arrange transportation of patients for transferorreferralorinvestigations etc. in safe manner. The arrangement can be

out sourced or self owned

18.LegalorStatutory Requirements

8.1

Compliance with local regulations and law.

Indicative list of legal requirement is as per Appendix 6.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

19.Record Maintenance and reporting:

9.6.

The minimum medical records to be maintained and nature of information to be provided by the Hospitals shall be as prescribed by the Clinical Establishment Act

9.7.

Medical Records shall be maintained in physical or digital format.

9.8.

The hospital shall ensure confidentiality, security and integrity of records.

9.9.

The medical records of IPD patients shall be maintained in consonance with National or local law, MCI guidelines, and court orders.

9.10.

The Hospital shall maintain health information and statistics in respect of national programmes, notifiable diseases and emergenciesordisastersor epidemics and furnish the same to the district authorities in the prescribed formats and frequency.

For content of medical record refer to Appendix7

20.Basic Processes

10.27.

10.28.

Patient shall be guided and informed regarding Patients’ rights & responsibilities, cost estimates, third party services (e.g. Insurance) etc.Appendix 8.

10.29.

The billing shall be as per the Hospital tariff list, which shall be available to patients in a suitable format.

10.30.

Each patient shall undergo an initial assessment by qualified andoror trained personnel.

10.31.

10.32.

The hospital shall ensure adequate and proper spacing in the patient care area so as to prevent transmission of infections.

10.33.

Regular cleaning of all areas with disinfectant shall be done .

10.34.

Housekeepingorsanitary services shall ensure appropriate hygiene and sanitation in the establishment.

10.35.

At the time of admission of patient, general consent for admission shall be taken.

10.36.

In case of non-availability of beds or where clinical need warrants, the patient shall be referred to another facility along with the required clinical information or notes.

10.37.

Reassessments of the admitted patients shall be done at least once in a day andoror according to the clinical needs and these shall be documented.

10.38.

Any examination, treatment or management of female patient shall be done in the presence of an employed female attendantorfemale nursing staff, if conducted by male personnel inside the hospital and vice versa

10.39.

The patient and family shall be treated with dignity, courtesy and politeness.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

10.40.

The Hospital shall provide care of patient as per Standard Treatment Guidelines that may be notified by the Central orState Government (Desirable)

10.41.

10.42.

Prescription shall include name of the patient, date, name of medication, dosage, route, frequency, duration, name, signature and registration number of the medical practitioner in legible writing.

10.43.

Drug allergies shall be ascertained before prescribing and administration; if any allergy is discovered, the same shall be communicated to the patient and recorded in the case sheet as well.

10.44.

Patient identity, medication, dose, route, timing, expiry date shall be verified prior to administration of medication.

10.45.

Patients shall be monitored after medication administration and adverse drug reactionorevents if any shall be recorded and reported.

10.46.

The hospital shall follow standard precautions like practicing hand hygiene, use of personal protection equipment etc.so as to reduce the risk of healthcare associated infections.

10.47.

Security and safety of patients, staff, visitors and relatives shall be ensured by provision of appropriate safety installations and adoption of appropriate safety measures.

10.48.

The patient andoror family members are explained about the disease condition, proposed care, including the risks, alternatives and benefits. They shall be informed on the expected cost of the treatment. They shall also be informed

10.49.

about the progress and any change of condition.

Informed consent shall be obtained from the patientor next of kinor legal guardian as and when required as per the prevailing Guidelines or Rules and regulations in the language patient can understand (for e.g. before Invasive procedures, Blood transfusion, HIV testing, etc.).Appendix 9

10.50.

A Discharge summary shall be given to all patients discharged from the hospital.

10.51.

DischargeorDeath summary shall also be given to patient andoror attendant in case of transfer LAMAorDAMA or death

10.52.

The discharge summary shall include the points as mentioned in the Appendix in an understandable language and format. For content of discharge summary refer to Appendix 10.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

APPENDIX 1

Minimum space requirements in a hospital level 1 shall be as follows:

Note: Structural changes should be applicable to the Nursing home or Hospitals constructed after the implementation of CEA since it is not possible to change the existing structures, especially with restrictions of building bye-laws

CEAorHospital – 001

Area (Desirable)

Wards

Ward bed and surrounding space

6sqmor bed;

Desirable: in addition circulation space of 30% as indicated in total area shall be provided for Nursing station, Ward store, Sanitary etc

Minor Operation TheatreorProcedure room

OT for minor procedures (where applicable)

10.5sqm

(Desirable)

Labour room

Labour Table and surrounding space

10.5 sqmor labour table

Other areas- nursing station, doctors’ duty room, store, Clean and dirty utility, Circulating area, Toilets

10.5 sqm for clean utility and store and 7 sqm for dirty utility and 3.5 sqm for toilet

Bio-medical Waste

5 sqm

Other functional areas( laboratory, diagnostics, front officeorreception, waiting area, administrative area etc.) should be appropriately sized as per the scope of service and patient load of the hospital

Other requirements:

Wards:

6. The ward shall also have designated areas for nursing station, doctors’ duty room, store, clean and dirty utility, janitor room, toilets and this shall be provided from circulation area.

7. For a general ward of 12 beds, a minimum of 1working counter and 1 hand wash basin shall be provided.

8. Distance between beds shall be 1.0 metres(Desirable).

9. Space at the head end of bed shall be 0.25 metres.

10. Door width shall be 1.2 metres (Desirable) and corridor width 2.5 metres(Desirable).

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

Labour room:

6. The obstetrical unit shall provide privacy, prevent unrelated traffic through the unit and provide reasonable protection of mothers from infection and from cross-infection.

7. Measures shall be in place to ensure safety and security of neonates.

8. Resuscitation facilities for neonates shall be provided within the obstetrical unit and convenient to the delivery room.

9. The labour room shall contain facilities for medication, hand washing, charting, and storage for supplies and equipment.

10. The labour room shall be equipped with oxygen and suction

Emergency room(if available)

24. Emergency bed and surrounding space shall have minimum 10.5 sq mor bed area(Desirable).

CEAorHospital – 001

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

APPENDIX 2

FURNITURE AND FIXTURES

sn ARTICLES

1 Examination Table

2 Writing tables

3 Chairs

4 Almirah

5 Waiting Benches

6 MedicalorSurgical Beds

7 Labour Table- if applicable

8 Wheel ChairorStretcher

9 Medicine Trolley, Instrument Trolley

10 Screensorcurtains

11 Foot Step

12 Bed Side Table

13 Baby Cot- if applicable

14 Stool

15 Medicine Chest

16 Examination Lamp

17 View box

18 Fans

19 Tube Lightor lighting fixtures

20 Wash Basin

21 IV Stand

22 Colour coded bins for BMW

*This is an indicative list and the items shall be provided as per the size of the hospital and scope of service.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

APPENDIX 3

EQUIPMENTS

c. EMERGENCY EQUIPMENT

S. No.

Name of Emergency Equipment

Resuscitation equipment including Laryngoscope, endotracheal tubes, suction equipment, xylocaine spray, oropharyngeal and nasopharyngeal airways, Ambu Bag- Adult &Paediatric (neonatal if indicated)

Oxygen cylinders with flow meteror tubingorcatheterorface maskornasal prongs

Suction Apparatus

Defibrillator with accessories (Desirable)

Equipment for dressingorbandagingorsuturing

Basic diagnostic equipment- Non mercury Blood Pressure Apparatus, Stethoscope, weighing machine, thermometer (Non mercury)

ECG Machine

Pulse Oximeter (Desirable)

Nebulizer with accessories

d. Other equipment and consumables, which shall also be available in good working condition as per the scope of services and bed strength (some of the emergency equipment are already mentioned above).

Department

Equipment

Level 1A

Level 1B

Level 2

Level 3

NON MEDICAL

Administration

Office equipment

Yes

Office furniture

Yes

Electricity

Emergency lights

Yes

Water Supply

Hand-washing sinksortapsorbowls on stands in all areas

Yes

Storage tank

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Waste Disposal

Water purification chemicals or filter Water source for drinking water

Buckets for contaminated waste in all treatment areas Drainage system Rubbish bins in all rooms

Sanitation facilities for patients

Separate Bio-medical waste disposal Sharps containers in all treatment areas

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Desirable Desirable Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Safety

Fire extinguisher Vehicle(OwnorOutsourced)

Vehicle wheeler Ambulance

Lockable storage

Medical Stores

Refrigeration Kitchen(OwnorOutsourced)

Cooking pots and utensils

Cooking stove

Food refrigeration Plates, cups & cutlery

Washing and drying area facilities

Detergentorsoap

Storage Yes Yes

Yes

Laundry(OwnorOutsourced)

Washing and rinsing equipmentorbowls

Yes

Housekeeping(OwnorOutsourced)

Housekeeping Brooms, brushes and mops

Buckets

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Soap and disinfectant

Yes

MEDICAL

Yes

Yes Yes Yes Yes

Yes Yes

Yes Yes Yes

Yes

Outpatient Rooms

Non Mercury Blood Pressure Apparatus and stethoscope

Yes Yes

Yes

Container for sharps disposal

Yes Yes

Yes

Desk and chairs

Yes Yes

Yes

Examination gloves

Yes Yes

Yes

Examination table

Yes Yes

Yes

Hand washing facilities

Yes Yes

Yes

Light source

Yes Yes

Yes

Minor surgical instruments

No Yes

Yes

Ophthalmoscope

No No

Yes (as applicabl e)

Otoscope

No No

Yes (as applicabl e)

Patellar hammer

Yes Yes

Yes

Receptacle for soiled pads, dressings, etc.

Yes Yes

Yes

Separate biohazard disposal

Yes Yes

Yes

Sterile equipment storage

Yes Yes

Yes

Sutures

Yes Yes

Yes

Thermometer(Non mercury)

Yes Yes

Yes

Torch with extra batteries

Yes Yes

Yes

Weighing scale

Yes Yes

Yes

Women and Child health examination room

Non Mercury Blood Pressure Apparatus and stethoscope

Yes

Contraceptive supplies

Yes

Birth register

Yes

Examination gloves

Yes

Examination table with stirrups

Yes

Fetal stethoscope

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Doppler

Hand washing facility

Yes

Height measure

Yes

IUD insertion set

Yes

Pregnant woman Register

Yes

Speculum and vaginal examination kit

Yes

Syringes and needles

Yes

Tape measure

Yes

Tococardiograph

Yes

Labour room

Yes Yes Yes Yes Yes

Yes

Yes Yes Yes

Yes Yes

Yes Yes Yes

Yes Yes Yes Yes Yes

Yes Yes Yes

Yes

Yes Yes

Baby scales

Yes Yes

Yes

Non Mercury Blood Pressure Apparatus and stethoscope

Yes Yes

Yes

Clean delivery kits and cord ties

Yes Yes

Yes

Curtains if more than one bed

Yes Yes

Yes

Delivery bed and bed linen

Yes Yes

Yes

Fetal stethoscope

Yes Yes

Yes

Hand washing facility

Yes Yes

Yes

Instrument trolley

Yes Yes

Yes

IV treatment sets

Latex gloves and protective clothing

Oxygen cylinderorconce

ntrator

Suction machine

Yes Yes

Yes

Yes Yes

Yes

Linens for newborns

Yes Yes

Yes

Mucus extractor

Yes Yes

Yes

Oral airways, various sizes

Yes Yes

Yes

Partograph charts

Yes

Self inflating bag and mask – adult and neonatal size

Yes Yes

Yes

Suturing sets

Yes Yes

Yes

Thermometer(Non mercury)

Yes

Tray with routine & emergency drugs, syringes and needles

Yes Yes

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Inpatient Wards

Urinary catheters and collection bags

Vacuum extractor set Work surface near bed for newborn resuscitation

Basic examination equipment (stethoscope, Non mercury BP Apparatus (etc)

Beds, washable mattresses and linen Curtains

Dressing sets Dressing trolleyorMedicine trolley

Gloves

IV stands

Medicine storage cabinet

Oxygen cylinder and concentrator Patient trolley on wheels

PPE kits

Suction machine Urinals and bedpans

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes If available

Yes Yes

OperationTheatre

Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes

No Yes Yes Yes Yes Yes Yes

Adequate storage Yes

Ambu resuscitation set Yes with adult and child

masks

Defibrillator

Electro cautery No

Fixed operating lights

Hand washing facilities

Yes

Fixed suction machine No

Yes

Instrument tray Yes

Instrument trolley

Yes

Laryngoscope set No

Mayo Stand

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Mobile operating light Yes Ophthalmic Operating No Microscope

Yes Yes

No Yes (as

applicabl e)

Yes

Yes Yes

Yes

Yes (as applicable )

Yes

Yes Yes

Yes

Yes Yes Yes

Yes Yes Yes Yes

Yes Yes

Yes Yes Yes

Oral airways, various No

sizes

Oxygen cylinder and Yes Yes Yes concentrator

Patient trolley on Yes

wheels

Portable suction Yes Yes Yes machine

Safety Box No

Sphygmomanometer Yes

(Non Mercury) and

stethoscope

Stool adjustable height No

Operating table No Yes Yes IV Therapy Equipment No

Anesthesia Equipment No

Anesthetic

trolleyormachine

CO2 Monitor No

O2 Monitor No Yes

Yes Yes Yes

Yes No No

Endoscopic equipment No

and necessary

accessories

Bronchoscope No No Desirable

Colonoscope No

Endoscope No No Desirable

No Desirable No Desirable

Fiber Optic No

Laryngoscope Central Supply

Amputation set No

Caesareanorhysterecto No No Yes my set

Dilatation and No

curettage set

No No No Yes

Endoscopic instrument cleaning machines

and solutions

Laparotomy set

Yes

Locked storage

Yes

Hernia set No Linens Yes Operating drapes No

No Yes Yes Yes Yes Yes

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Ophthalmic instrument

Yes

Protective caps, aprons, shoes and gowns etc.

Yes

Pelvicorfistula repair set

Yes

Sterile gloves

Yes

Sterilization equipment for instrument and linens

Yes

Surgical supplies (e.g., sutures, dressings, etc.)

Yes

Thoracocentesis set

Yes

Thoracostomy set with appropriate tubes and water seal bottles

Yes

Thoracotomy set

Yes

ThyroidorParathyroid set

Yes

Tracheostomy set

Yes

Tubal ligation set

Yes

Vascular repair set

Yes

Other equipment as per the specialized services available shall also be there.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

APPENDIX 4

DRUGS, MEDICAL DEVICES AND CONSUMABLES

Name of the Drug

1. INJECTIONECTIONS

2. INJECTION. DIAZEPAM 10 MG

3. INJECTION. FRUSEMIDE 20 MG

4. INJECTION. ONDANSETRON 8 MGor4ML

5. INJECTION. RANITIDINE

6. INJECTION NOR ADRENALINE 4 MG

7. INJECTION. PHENYTOIN 50 MG

8. INJECTION DICLOFENAC 75 MG

9. INJECTION. DERIPHYLLINE

10. INJECTION CHLORPHENIRAMINE MALEATE

11. INJECTION. HYDROCORTISONE 100 MG

12. INJECTION. ATROPINE 0.6 MG

13. INJECTION. ADRENALINE 1 MG

14. INJECTION. KCL

15. STERILE WATER

16. INJECTION. SODA BICARBONATE

17. INJECTION. DOPAMINE

18. INJECTION. NALAXONE 400 MCG

19. INJECTION. LIGNOCAINE 50 ML

20. TAB. SORBITRATE

21. TAB. ASPIRIN

22. INJECTION. TETANUS

23. OTHER

24. NEB. SALBUTAMOL2.5 ML

25. NEB. BUDESONIDE

c. List of Emergency Drugs and consumables (Essential in all hospitals)

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

26.

LIGNOCAINE JELLY 2%

27.

ACTIVATED CHARCOAL

28.

CALCIUM (INJECTION or TAB)

29.

FLUIDS

30.

RL 500 ML

31.

NS 500 ML

32.

NS 250 ML

33.

NS 100 ML

34.

DNS 500 ML

35.

DEXTROSE 5% 500 ML

36.

DEXTROSE 10% 500 ML

37.

PEDIATRIC IV INFUSION SOLUTION 500 ML

d. The other drugs and consumables shall be available as per the scope of services, bed strength and patient turnover.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

APPENDIX 5

HUMAN RESOURCE

The Human Resource requirement for any hospital depends on the scope of services provided by the hospitals, bed strength and workload of the hospital.

However on the basis of level of care provided the minimum staffing requirements for Hospital level 1 shall be as follows:

CEAorHospital – 001

Doctor

Qualified doctor shall be available round the clock on site(Desirable for 1A). Level 1A shall have a MBBS qualified doctor.

(Qualified doctor is a MBBS approved as per state government rules & regulations as applicable from time to time).

Level 1B shall have MBBS doctor with required post-graduation qualification.

Nurses

Qualified nurses per unit per shift shall be available as per requirement laid down by“The Indian Nursing Council, 1985”, occupancy rate and distribution of bed.

(Desirable)

Pharmacist (If in house pharmacy available)

1 in a hospital

10.

Lab Technician (if in house laboratory service available)

1 in a hospital (minimum DMLT) BSc, MSc ,MLT(Desirable)

11.

X-ray Technician (if in house X-ray facility available)

1 in a hospital (minimum Diploma in X Ray Technician course)

Minimum 1

12.

Multi Task staff

Requirement of other staff (Support and administrative) will depend on the scope of the hospital.

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

APPENDIX 6

LIST OF LEGAL REQUIREMENTS

Below is the list of legal requirements to be complied with by a hospital as applicable by the localorstate health authority (all may not be applicable):

CEAorHospital – 001

SN Name of Document

1 Registration under Nursing Home Actor Medical Establishment Act

2 Bio-medical Waste Management Licenses Authorization of HCO by PCB

MOU with Vendor

3 AERB Licenses (As per AERB regulations)

4 NOC from Fire Department

5 Ambulance

Commercial Vehicle Permit Commercial Driver License Pollution Control Licenses

6 Building Completion Licenses

7 Lift license for each lift

8 DG Set Approval for Commissioning*

9. Diesel Storage Licenses*

10 Retail and bulk drug license (pharmacy)

11 Food Safety Licenses*

12 Narcotic Drug Licenses*

13 Medical Gases Licensesor Explosives Act*

14 Clinical Establishments and Registration (if

applicable)

15 Blood Bank Licenses

16 MoU or agreement with outsourced human

resource agencies as per labor laws

17 Spirit License

18 Electricity rules

19 Provident fundorESI Act

20 MTP Act

21 PNDT Act

23 PAN

25 Arms Act, 1950 (if guards have weapons) * (as per regulations of State)

Valid Valid From Till

Send for renewal by

Remark

(Expiredo r validorNA )

Sales Tax registration

No objection certificate under Pollution Control Act (AirorWater)

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

APPENDIX 7

CONTENT OF MEDICAL RECORD

Medical record shall contain, at the least, the following information:

CEAorHospital – 001

Content

Name & Registration number of treating doctor

Name, demographic details & contact number of patient

Relevant Clinical history, Assessment and re-assessment findings, nursing notes and Diagnosis

Investigation reports

Details of medical treatment, invasive procedures, surgery and other care provided

Applicable consents

Discharge summary

Cause-of-death certificate & Death Summary (where applicable)

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

APPENDIX 8 Patients’ rights and responsibilities:

A patient and hisorher representative has the following rights with respect to the clinical establishment-

51. To adequate relevant information about the nature, cause of illness, proposed investigations and care, expected results of treatment, possible complications and expected costs;

53. To access a copy of case papers, patient records, investigations reports and detailed bill.

54.To informed consent priorto specific testsortreatment (e.g. surgery, chemotherapy)

55. To seek second opinion from an appropriate clinician of patients’ choice, with records and information being provided by treating hospital

56. To confidentiality, human dignity and privacy during treatment.

57. To have ensured presence of a female person, during physical examination of

a female patient by a male practitioner.

58. To non-discrimination about treatment and behaviour on the basis of HIV

status

59. To choose alternative treatment if options are available

Provide all health related information

Cooperate with Doctors during examination, treatment

Follow all instructions

Pay hospitals agreed fees on time

Respect dignity of doctors and other hospital staff

Never resort to violence

CEAorHospital – 001

Patients’ Rights

52. To information on the Rates charged for each type of service provided and

facilities available. Clinical Establishment shall display the same at a

conspicuous place in the local as well as in English language.

Patients’ Responsibilities

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

CEAorHospital – 001

APPENDIX 9

INFORMED CONSENTorCONSENT GUIDELINES

The informed consent shall at the least contain the following information in an understandable language and format (desirably which a lay person can easily understand)

Content

Name of the patientor guardian (in case of minorormentally disabled).

Registration number of patient

Date of admission

Name & Registration number of treating doctor

Name of procedureoroperationorinvestigationorblood transfusionoranaesthesia and potential complications should be explained

Signature of patientorguardian with date and time

Clinical Establishments Act Standards for Hospital (LEVEL 1A &1B))

APPENDIX 10

DISCHARGE SUMMARY

The discharge summary shall at the least contain the following information in any understandable language and format:

CEAorHospital – 001

Content

Name & Registration number of treating doctor

Name, demographic details & contact number of patient, if available

Date of admission and discharge

Relevant clinical history, assessment findings and diagnosis

Investigation results,

Details of medical treatment, invasive procedures, surgery and other care provided

Discharge advice (medications and other instructions).

Instruction about when and how to obtain urgent care.

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

Clinical Establishments Act

Standard for

HOSPITAL (LEVEL 2) Standard No. CEA orHospital – 002

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

Table of Contents

Particulars

Page No.

Categorization of Hospitals

Definition

Scope

Infrastructure

Equipments

Human Resource

LegalorStatutory Requirements

Record Maintenance and Reporting

Basic Processes

Appendix 1

Appendix 2

Appendix 3

Appendix 4

Appendix 5

Appendix 6

Appendix 7

Appendix 8

Appendix 9

Appendix 10

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

Categorization of Hospitals

The minimum standards for Allopathic hospitals Under Clinical Establishment Act, 2010 are developed on the basis of level of care provided, as defined below:

Hospital Level 1 (A)-

General Medical services with indoor admission facility provided by recognized allopathic medical graduate(s) and may also include general dentistry services provided by recognized BDS graduates.

Example: PHC, Government and Private Hospitals and Nursing Homes run by MBBS Doctors etc.

Hospital Level 1(B) –

Level 1(A) and Level 1(B) Hospitals shall also include support systems required for the respective services like Pharmacy, Laboratory, etc.

Example: General Hospital, Singleor Multiple basic medical Specialties provided at Community Health Centre, Sub Divisional Hospital, and Private Hospital of similar scope, Nursing Home, Civil or District Hospital in few places etc.

Hospital Level 2 (Non-Teaching)

This level may include all the services provided at level 1(A) and 1(B) and services through other medical specialties given as under ,in addition to basic medical specialty given under 1(B) like:

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

1. Orthopaedics

2. ENT

3. Ophthalmology

4. Dental

5. Emergency with or without ICU

6. Anaesthesia

7. Psychiatry

8. Skin

9. Pulmonary Medicine

10. Rehabilitation, etc.

And support systems required for the above services like Pharmacy, Laboratory, Imaging facilities, Operation Theatre etc.

Example: District Hospital, Corporate Hospitals, Referral Hospital, Regionalor State Hospital, Nursing Home and Private Hospital of similar scope etc.

Hospital Level 3 (Non-Teaching) Super-specialty services –

Example: Corporate Hospitals, Referral Hospital, RegionalorState Hospital, Nursing Home and Private Hospital of similar scope etc.

Hospital Level 4 (Teaching) –

Clinical Establishments Act Standards for Hospital (LEVEL 2)

by their rules. However registration of teaching Hospitals will also be required under Clinical Establishment Act for purpose other than those covered under MCI such as, records maintenance and reporting of information and statistics, and compliance to range of rates for Medical and Surgical procedures, etc.

Clinical Establishment Act Standards for Hospital (LEVEL 2)

21. Definition

Hospitals usually have facility to admit and care for inpatients whilst the other clinical establishments are described as clinicsorpolyclinics or day care centres. There are other exceptions too like Hospice etc

The general hospital, may have multiple departments taking care of many kinds of disease and Injectionury, and normally has an emergency department to deal with immediate and urgent care.

Specialized hospitals may include trauma centers, rehabilitation hospitals, children’s hospitals, Mental hospitals or, and hospitals for dealing with specific medical needs such as psychiatric problems (psychiatric hospital) or Sanatorium, certain disease categories such as neurology, cardiology, oncology, or orthopaedic, IVF and so forth.

A hospital can be situated in rural or urban setting. It can be run by Public Sector (Central governmentorState governmentorLocal governmentorPublic Sector undertakingorRegistered Society etc) or by Private Sector (Individual Proprietorshipor Registered PartnershiporRegistered Company orCo-operative SocietyorTrust orCharitable etc).

Hospital Level 2 (Non-Teaching)

CEA orHospital- 002

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

This level may include all the services provided at level 1(A) and 1(B) and services through other medical specialties given as under ,in addition to basic medical specialty given under 1(B) like:

a. Orthopaedics

b. ENT

c. Ophthalmology

d. Dental

e. Emergency with or without ICU

f. Anaesthesia

g. Psychiatry

h. Skin

i. Pulmonary Medicine

j. Rehabilitation, etc.

And support systems required for the above services like Pharmacy, Laboratory, Imaging facilities, Operation Theatre etc.

Example: District Hospital, Corporate Hospitals, Referral Hospital, Regionalor State Hospital, Nursing Home and Private Hospital of similar scope etc.

22. Scope

The scope of services that may be provided at a hospital level 2 practising Allopathy – Modern system of Medicine may include patient-care services in any or all of the following specialities, but not necessarily limited to:

Clinical Services:

2.1. General Medicine

2.2. General Surgery

2.3. Obstetrics and Gynaecology

2.4. Paediatrics including new born care

2.5. Orthopaedics

2.6. Anaesthesiology

2.7. Emergency Medicine & Trauma

2.8. Critical Care Medicine (e.g. HDU, ICU)

2.9. ENT

2.10. Ophthalmology

Clinical Establishments Act Standards for Hospital (LEVEL 2)

2.11. Psychiatry

2.12. Dermatology

2.13. Community Health and Family Medicine

2.14. Palliative Medicine

2.15. Geriatric Care

2.16. Dentistry including sub specialities

2.17. Physical Medicine & Rehabilitation

2.18. Transfusion MedicineorBlood Storage CentreorBlood Bank 2.19. Other emerging sub-specialities in any of the above fields.

Support services:

2.20. Registration or help desk and billing

2.21. Diagnostic Services (OwnorOutsourcedorTie up)

a. Laboratory

b. Imaging Services

c. Non-imaging services

2.22. Pharmacy and Stores

2.23. CSSD or Sterilization Area

2.24. Linen management

2.25. Kitchen & Dietary Services (OwnorOutsourced)

2.26. Waste Management Services (General and Biomedical) 2.27. Medical Gas Supply, Storage & Distribution

2.28. Ambulance services (OwnorOutsourced)

23.Infrastructure Requirements:

CEA orHospital- 002

3.1

Signage

3.1.1

The Hospital shall display appropriate signage which shall be in at least two languages

3.1.2

The building shall have a board displaying the name of the hospital at a prominent location

3.1.3

Directional signage shall be placed within the facility to guide the patient.

Following informative signage shall be displayed:

3.1.4

Name of the care provider with registration number

3.1.5

Registration details of the hospital as applicable.

3.1.6

Availability of fee structure of the various services provided (refer to CEA 2010 rules & regulation).

3.1.7

Timings of the facility and services provided.

3.1.8

Mandatory information such as under PNDT Act etc. prominently as applicable.

3.1.9

Important contact numbers such as Blood Banks, Fire Department, Police and Ambulance Services available in the nearby area.

Following safety signage shall be displayed:

3.1.11

Safety Hazard and Caution signs, for e.g. hazards from electrical shock,

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

inflammable articles, radiation etc.at appropriate places, and as applicable under law.

3.1.12

Appropriate Fire exit signage.

3.1.13

Signage for “No Smoking”.

3.2.

Other requirements

3.2.1

Access to the hospital shall be comfortable for the patient andoror attendantsorvisitors.

3.2.2

Access shall be provided within the requirements of “Persons with Disabilities Act” and shall be easy for all those whose mobility may be restricted due to

3.2.3

whatever cause.

The hospital shall be developed and maintained to provide safe, clean and hygienic environment for patients, their attendants, staff and visitors

3.2.4

The hospital shall have 24hr provision of potable water for drinking & hand hygiene. It shall also have 24hr supply of electricity, either through direct supply or from other sources.

3.2.6

The hospital shall have clean public toilet(s) separate for males and females.

3.2.7

The hospital shall have mechanism for timely maintenance of the hospital building and equipment.

3.2.8

The hospital shall have appropriate internal and external communication facilities.

3.2.9

Furniture and fixtures shall be available in accordance with the activities and workload of the hospital. They shall be functional and properly maintained.

For minimum space requirements refer to Appendix 1

For indicative list of furniture and fixtures refer to Appendix 2

24. Medical Equipment and Instruments:

25.Drugs, Medical devices and Consumables:

4.1

The hospital shall have adequate medical equipment and instruments, commensurate to the scope of service and number of beds

4.2

There shall be established system for maintenance of critical Equipment

4.3

All equipment shall be kept in good working condition through a process of periodic inspection, cleaning and maintenance. Advisory-Annual Maintenance.

For indicative list of medical equipment and instruments refer toAppendix 3.

5.1

The hospital shall have adequate drugs, medical devices and consumables commensurate to the scope of services and number of beds

5.2

Emergency drugs and consumables shall be available at all times.

5.3

Drug storage shall be in a clean, well lit, and safe environment and shall be in consonance with applicable laws and regulations.

5.4

The facility has defined procedures for storage, inventory management and dispensing of drugs in pharmacy and patient care areas.

For indicative list of drugs, medical devices and consumables refer toAppendix 4.

26.Human Resource Requirements:

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

6.1

The hospital shall have qualified andoror trained medical staff as per the scope of service provided and the medicalcare.

6.2

The hospital shall have qualified andoror trained nursing staff as per the scope of service provided and the nursing care

6.3

The supportorparamedical staff shall be qualified andoror trained as per the scope of services provided.

6.4

For Human resource requirements refer toAppendix 5

27. Support Services:

RegistrationorHelp desk and Billing:

7.1

The Hospital shall have a Registrationor Help-desk & Billing counter, and the scope of this shall also include provision of patient guidance in matters like services available, cost estimation, healthcare insurance etc.

Diagnostic Services:.

7.2

Diagnostic services may be in-house or outsourced. For minimum standards for diagnostic services refer to CEA standards for Imaging and laboratory services.

7.3

Whether in house or outsourced, the services shall fulfil the requirements of safe and timely patient care.

7.4

The diagnostic services, whether in house or outsourced, shall be commensurate with the scope of services

Pharmacy Services

7.5

Pharmacy services in a hospital can be in-house or outsourced.

7.6

All applicable legal requirements shall be complied with.

7.7

Medicine storage shall be in a clean, well lit, and safe environment, and as per manufacturer’s requirements

CSSD or Sterilization Area

7.8

Provision for instrument and linen sterilization and storage of sterile items shall be made available as per the scope of services.

7.9

Validation of Sterilization shall be done for ensuring the effectiveness of sterilization process.

Linen management:

7.10

Soiled linen shall be collected, transported and washed separately in clean and hygienic environment.

7.11

Where linen is contaminated, appropriate decontamination shall be carried prior to despatch for washing.

Waste Management Services:

7.12

Segregation, collection, transportation, storage and disposal of biomedical waste shall be as per Bio medical waste handling rules.

7.14

Segregation, collection, transportation, storage and disposal of general waste shall be as per applicable local laws

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

Medical Gas

7.15

Oxygen for medical use shall be available. In addition other gases like Nitrous oxide, Carbon dioxide etc. may be available in consonance with the scope of services and bed strength.

7.16

Medical gases shall be stored and handled in a safe manner.

7.17

All applicable legal requirements shall be complied with.

7.18

Appropriate back-up and safety measures shall be in place to ensure patient safety at all times.

Ambulance services(OwnorOutsourced)

7.19

The establishment shall have provision of transporting patients for transferorreferralorinvestigations etc in safe manner.

7.20

Ambulance Services may be in-house or outsourced. The Ambulance services shall comply with the applicable local laws, even if they are outsourced.

28.LegalorStatutory Requirements:

29.Record Maintenance and reporting:

8.1

Every application must be accompanied with the documents confirming compliance with local regulations and law.

Indicative list is as per Appendix 6.

9.1

The minimum medical records to be maintained and nature of information to be provided by the Hospitals shall be as prescribed in Section 12 (1) (iii) of this Act.

9.2

Medical Records may be maintained in physical or digital format.

9.3

Confidentiality, security and integrity of records shall be ensured at all times

9.4

The medical records of IPD patients shall be maintained in consonance with National or local law, MCI guidelines, and court orders.

9.5

Every Hospital shall maintain health information and statistics in respect of national programmes, notifiable diseases and emergenciesordisastersor epidemics and furnish the same to the district authorities in the prescribed formats and frequency.

Content of medical record shall be as per Appendix 7

30.Basic Processes:

Registration or help desk and billing services

10.1.

The hospital shall register all patients who visit the hospital except if the required services are not available in the facility, in which case the patient is guided to the appropriate nearest facility. (Please also see Emergency Services)

10.2.

Once registered, depending on the clinical need, patient is guided to appropriate service area like OPD, ER etc.

10.3.

Patient shall be guided and informed regarding Patients’ rights & responsibilities, cost estimates, third party services (e.g. Insurance) etc. Please refer to Appendix 8.

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

10.4.

The billing shall be as per the Hospital tariff list, which shall be available to patients in a suitable format.

Assessment and Plan of care

10.5.

Each patient shall undergo an initial assessment by qualified andoror trained personnel.

10.6.

Further management of patient shall be done by a Doctor on the basis of findings of initial assessment; for example, OPD treatment, admission, transferorreferral, investigation etc.

10.7.

At the time of admission of patient, General Consent for admission shall be taken.

10.8.

In case of non-availability of beds or where clinical need warrants, the patient shall be referred to another facility along with the required clinical information or notes.

10.9.

Reassessments of the admitted patients shall be done at least once in a day andoror according to the clinical needs and these shall be documented.

10.10.

Any examination, treatment or management of female patient shall be done in the presence of an employed female attendantorfemale nursing staff, if conducted by male personnel inside the hospital and vice versa.

Informed Consent Procedure

10.11.

Informed consent shall be obtained from the patientor next of kinor legal guardian as and when required as per the prevailing Guidelines or Rules and regulations in the language patient can understand (for e.g., before Invasive procedures, anaesthesia, Blood transfusion, HIV testing, Research, etc). Please refer to Appendix 9.

Care of Patient

10.12.

The Hospital shall provide care of patient as per Standard Treatment Guidelines that may be notified by the Central orState Government (Desirable)

10.13.

Patient andoror families shall be educated on preventive, curative, promotive and rehabilitative aspects of care either verbally, or through printed materials.

10.14.

All the relevant documents pertaining to any invasive procedures performed shall be maintained in the record.

10.15.

Monitoring of patient shall be done during and after all the procedures and same shall be documented (for example, after anaesthesia, surgical procedures, blood transfusion, etc.).

10.16.

Staff involved in direct patient care shall receive basic training in CPR

Emergency Services:

10.17.

Emergency patients shall be attended on priority. The Emergency department shall be well equipped with trained staff.

10.18.

Medication Prescription, Administration And Monitoring

10.19.

Prescription shall include name of the patient, date, name of medication,

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

dosage, route, frequency, duration, name, signature and registration number of the medical practitioner in legible writing

10.20.

Drug allergies shall be ascertained before prescribing and administration; if any allergy is discovered, the same shall be communicated to the patient and recorded in the Case sheet as well.

10.21.

Patient identity, medication, dose, route, timing, expiry date shall be verified prior to administration of medication

10.22.

Safe Injectionection practices shall be followed as per WHO guidelines.

10.23.

High Risk Medicines shall be identified and verified by trained healthcare personnel before administration.

10.24.

Patients shall be monitored after medication administration and adverse drug reactionorevents if any shall be recorded and reported

Infection Control

10.25.

The hospital shall follow standard precautions like practicing hand hygiene, use of personal protection equipment, etc to reduce the risk of healthcare associated infections.

10.26.

The hospital shall ensure adequate and proper spacing in the patient care area so as to prevent transmission of infections.

10.27.

Regular cleaning of all areas with disinfectant shall be done .

10.28.

Prescribed & documented Infection Control Practices shall be followed in High risk areas like Operation theatre, ICU, HDU, etc as per good clinical practice guidelines.

10.29.

Housekeepingorsanitary services shall ensure appropriate hygiene and sanitation in the establishment.

Safety of the patient, staff, visitors and relative in a hospital

10.30.

Security and safety of patients, staff, visitors and relatives shall be ensured by provision of appropriate safety installations and adoption of appropriate safety measures. E.g. identification of mother and baby in obstetric facility, etc

10.31.

The Hospital shall undertake all necessary measures, including demonstration of preparedness for fire and non-fire emergencies, to ensure the safety of patients, attendants, staff and visitors. (Please also see section on Infrastructure and Security and Fire)

10.32.

All applicable fire safety measures as per local law shall be adopted. This includes fire prevention, detection, mitigation, evacuation and containment measures. Periodic training of the staff and mock drills shall be conducted and the same shall be documented.

10.33.

In case of any epidemic, natural calamity or disaster, the ownerorkeeper of every Hospital shall, on being requested by the designated supervising Authority, cooperate and provide such reasonable assistance and medical aid as may be considered essential by the supervising authority at the time of natural calamity or disastrous situation

Patient Information and Education

10.34.

The patient andoror family members shall be explained about the disease condition, proposed care, including the risks, alternatives and benefits. They shall be informed regarding the expected cost of the treatment. They shall also be informed about the progress and any change of condition.

10.35.

Patient andoror family are educated about the safe and effective use of

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

medication, food drug interaction, diet, and disease prevention strategies.

Discharge

10.36.

A Discharge summary shall be given to all patients discharged from the hospital. For content of discharge summary refer to Appendix 10.

10.37.

The discharge summary shall include the points as mentioned in the Appendix in an understandable language and format

10.38.

Discharge summary shall also be given to patient andoror attendant in case of transfer LAMAorDAMA or death.

APPENDIX 1

Minimum space requirements in a hospital level 2 shall be as follows:

Area(Desirable)

Wards

Ward bed and surrounding space

6sq mor bed; in addition circulation space of 30% as indicated in total area shall be provided for Nursing station, Ward store, Sanitary etc

Intensive Care Unit (if available)

For medicalorsurgical ICUorHDU bed and surrounding space

10.5sqmor bed; in addition circulation space of 30% as indicated in the total area shall be provided for nursing station, doctors’ duty room, store, clean and dirty utility, circulating area for movement of staff, trolley, toilet etc.

Minor Operation TheatreorProcedure room

OT for minor procedures (where applicable)

10.5 sq m; in addition circulation space of 30% as indicated in total area shall be provided for nursing station, scrub station, clean and dirty utility, dressing room, toilet etc.

Labour room

Labour Table and surrounding space

10.5 sq mor labour table

Other areas- nursing station, doctors’ duty room, store, Clean and dirty utility, Circulating area, Toilets

10.5 sqm for clean utility and store and 7 sqm for dirty utility and 3.5 sqm for toilet.

Operation Theatre (OT)

Operating Room Area

24.5sq m per operating room.

Emergency & Casualty (if separate):

Emergency bed and surrounding

10.5 sq mor bed

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

space

Other areas- nursing station, doctors’ duty room, store, Clean and dirty utility, Dressing area, Toilets

Nurse station out of circulation. Doctor duty room of 7sqm and a toilet of 3.5sqm. Store of 7sqm

Pharmacy

The size should be adequate to contain 5 percent of the total clinical visits to the OPD in one session at the rate of 0.8 m2 per

patient.

Bio-medical Waste

10.

<50 beds

5 sq m

11.

50-100 beds

>100 beds

10 sq m

12.

20 sq m

Other functional areas(laboratory, diagnostics, front officeorreception, waiting area, administrative area etc) should be appropriately sized as per the scope of service and patient load of the hospital.

Other requirements:

Wards:

1. The ward shall also have designated areas for nursing station, doctors’ duty room, store, clean and dirty utility, janitor room, toilets and this shall be provided from circulation area.

2. For a general ward of 12 beds, a minimum of 1 WC and 1 hand wash basin shall be provided.

3. Distance between beds shall be 1.0 metres

4. Space at the head end of bed shall be 0.25 metres.

5. Door width shall be 1.2 metres and corridor width 2.5 metres

Intensive Care Unit (if available)

1. The unit is to be situated in close proximity of operation theatre, acute care medical and surgical ward units.

2. Suction, oxygen supply and compressed air should be provided for each bed.

3. Adequate lighting and uninterrupted power supplyshall be provided.

4. Adequate multi-sockets with 5 ampere and 15 ampere sockets andoror as per requirement to be provided for each bed.

Clinical Establishments Act Standards for Hospital (LEVEL 2)

5. Nurse call system for each bed is desirable

6. ICU shall have designated area for nursing station, doctors’ duty room, store, clean and dirty utility, circulating area for movement of staff, trolley, toilet, shoe change, trolley bay, janitor closet etc

Labour room:

11. The obstetrical unit shall provide privacy, prevent unrelated traffic through the unit and provide reasonable protection of mothers from infection and from cross-infection.

12. Measures shall be in place to ensure safety and security of neonates.

13. Resuscitation facilities for neonates shall be provided within the obstetrical unit and convenient to the delivery room.

14. The labour room shall contain facilities for medication, hand washing, charting, and storage for supplies and equipment.

15. The labour room shall be equipped with oxygen and suction

Operation Theatre

1. The operation theatre complex shall have appropriate zoning.

2. The operation theatre complex shall provide appropriate space for other areas- nursing station, doctors’ duty room, scrub station, sterile store, Clean and dirty utility, Dress change room, Toilets.

a. Sterile area – consists of operating room sterile store and anesthesia room

b. Clean zone- consists of equipmentormedical store, scrub area, pre andoror post-operative area and linen bay

c. Protective zone- consists of change room, doctors room and toilets

d. Dirty area

e. Due considerations are to be given to achieve highest degree of asepsis to

provide appropriate environment for staff and patients.

3. Doors of pre-operative and recovery room are to be 1.5 m clear widths.

CEA orHospital- 002

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

4. Air Conditioning to be provided in all areas. Window AC and split units should preferably be avoided as they are pure re circulating units and become a source of infection.

5. Appropriate arrangements for air filtration to be made.

6. Temperature and humidity in the OT shall be monitored.

7. Oxygen, Nitrous Oxide, suction and compressed air supply should be provided in

all OTs.

8. All necessary equipment such as shadow-less light, Boyle’s apparatus shall be available and in working condition.

9. Uninterrupted power supply to be provided.

Note: For Eye Hospitals only where procedures are done in local andoror regional anaesthesia, Minor OT criteria may be applicable.

Emergency room

25. Emergency bed and surrounding space shall have minimum 10.5 sq mor bed area.

Clinical Laboratory

1. The laboratory area shall be appropriate for activities including test analysis, washing, biomedical waste storage and ancillary services like Storage of records, reagents, consumables, stationary etc eating area for staff.

Imaging

1. The department shall be located at a place which is easily accessible to both OPD and wards and also to emergency and operation theatre.

2. As the department deals with the high voltage, presence of moisture in the area shall be avoided.

3. The size of the department shall depend upon the type of equipment installed.

4. The departmentorroom shall have a sub-waiting area preferably with toilet facility and a change room facility, if required.

Central Sterilization and Supply

1. Department (CSSD) — Sterilization, being one of the most essential services in a hospital, requires the utmost consideration in planning.

2. Centralization increases efficiency, results in economy in the use of equipment and ensures better supervision and control.

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

3. The materials and equipment dealt in CSSD shall fall under three categories: a) Those related to the operation theatre department,

b) Common to operating and other departments, and

c) Pertaining to other departments alone.

Other Departments

Other departments shall have appropriate infrastructure commensurate to the scope of service of the hospital.

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

APPENDIX 2 Furniture and Fixtures:

ARTICLES

Examination Table Writing tables Chairs

Almirah

Waiting Benches

MedicalorSurgical Beds

Labour Table- if applicable

Wheel ChairorStretcher

Medicine Trolley, Instrument Trolley Screensorcurtains

Foot Step

Bed Side Table

Baby Cot- if applicable

Stool

Medicine Chest

Examination Lamp

View box

Fans

Tube Lightor lighting fixtures

Wash Basin

IV Stand

Colour coded bins for BMW

*This is an indicative list and the items shall be provided as per the size of the hospital and scope of service.

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

APPENDIX 3 EQUIPMENTS

e. Emergency Equipment

Sr No

Name of Emergency Equipment

Resuscitation equipment including Laryngoscope, endotracheal tubes, suction equipment, xylocaine spray, oropharyngeal and nasopharyngeal airways, Ambu Bag- Adult & Paediatric (neonatal if indicated)

Oxygen cylinders with flow meteror tubingorcatheterorface maskornasal prongs

Suction Apparatus

Defibrillator with accessories

Equipment for dressingorbandagingorsuturing

Basic diagnostic equipment- Non Mercury Blood Pressure Apparatus, Stethoscope, weighing machine, thermometer(Non mercury)

ECG Machine

Pulse Oximeter

Nebulizer with accessories

f. Other equipment and consumables, which shall also be available in good working condition as per the scope of services and bed strength (some of the emergency equipment are already mentioned above).

Department

Equipment

Level 1A

Level 1B

Level 2

Level 3

NON MEDICAL

Administration

Office equipment

Yes

Office furniture

Yes

Electricity

Emergency lights

Yes

Water Supply

Hand-washing sinksortapsorbowls on stands in all areas

Yes

Storage tank

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

Waste Disposal

Water purification chemicals or filter Water source for drinking water

Buckets for contaminated waste in all treatment areas Drainage system Rubbish bins in all rooms

Sanitation facilities for patients

Separate Bio-medical waste disposal Sharps containers in all treatment areas

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Desirable Desirable Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Safety

Fire extinguisher Vehicle(OwnorOutsourced)

Vehicle wheeler Ambulance

Lockable storage

Medical Stores

Refrigeration Kitchen(OwnorOutsourced)

Cooking pots and utensils

Cooking stove

Food refrigeration Plates, cups & cutlery

Washing and drying area facilities

Detergentorsoap

Storage Yes Yes

Yes

Laundry(OwnorOutsourced)

Washing and rinsing equipmentorbowls

Yes

Housekeeping(OwnorOutsourced)

Housekeeping Brooms, brushes and mops

Buckets

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

Soap and disinfectant

Yes

MEDICAL

Yes

Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes (as Yes applicabl

Yes Yes Yes Yes

Yes Yes

Yes Yes Yes Yes

Outpatient Rooms

Non Mercury Blood Pressure Apparatus and stethoscope

Yes Yes

Container for sharps disposal

Yes Yes

Desk and chairs

Yes Yes

Examination gloves

Minor surgical instruments

Yes Yes

Examination table

Yes Yes

Hand washing facilities

Yes Yes

Light source

Yes Yes

No Yes

Ophthalmoscope

No No

Otoscope

No No

Patellar hammer

Yes Yes

Receptacle for soiled pads, dressings, etc.

Yes Yes

Separate biohazard disposal

Yes Yes

Sterile equipment storage

Weighing scale

Yes Yes

Sutures

Yes Yes

Thermometer(Non mercury)

Yes Yes

Torch with extra batteries

Yes Yes

Women and Child health examination room

Non Mercury Blood Pressure Apparatusand stethoscope

Yes Yes

Contraceptive supplies

Yes Yes

Birth register

Yes Yes

Yes

Examination gloves

Yes Yes

Examination table with stirrups

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

Labour room

Fetal stethoscope Doppler

Hand washing facility Height measure

IUD insertion set Pregnant woman Register

Speculum and vaginal examination kit Syringes and needles Tape measure Tococardiograph

Baby scales

Non Mercury Blood Pressure Apparatus and stethoscope

Clean delivery kits and cord ties

Curtains if more than one bed Delivery bed and bed linen

Fetal stethoscope

Hand washing facility Instrument trolley

IV treatment sets

Latex gloves and protective clothing Linens for newborns Mucus extractor

Oral airways, various sizes

Oxygen

cylinderor concentrator

Self inflating bag and mask – adult and neonatal size

No Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Partograph charts

Suction machine

Thermometer(Non mercury)

Yes

Suturing sets

Tray with emergency

routine & drugs,

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

Inpatient Wards

syringes and needles Urinary catheters and collection bags

Vacuum extractor set Work surface near bed for newborn resuscitation

Basic examination equipment (stethoscope, Non mercury BP Apparatus (etc)

Beds, washable mattresses and linen Curtains

Dressing sets Dressing trolleyorMedicine trolley

Gloves

IV stands

Medicine storage cabinet

Oxygen cylinder and concentrator Patient trolley on wheels

PPE kits

Suction machine Urinals and bedpans

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes If available

Yes Yes

OperationTheatre

Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes

No Yes Yes Yes Yes Yes Yes

Adequate storage Yes

Ambu resuscitation set Yes with adult and child

masks

Defibrillator

Electro cautery No

Fixed operating lights

Yes

Fixed suction machine No

Hand washing facilities

Yes

Instrument tray Yes

Instrument trolley

Yes

Laryngoscope set No

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

Mayo Stand Yes Yes Yes

Yes

Yes (as applicable )

Yes

Yes Yes

Yes

Yes Yes Yes

Yes Yes Yes Yes

Yes Yes

Mobile operating light Yes Ophthalmic Operating No Microscope

Yes Yes

No Yes (as

applicabl e)

Yes

Oral airways, various No

sizes

Oxygen cylinder and Yes Yes Yes concentrator

Patient trolley on Yes

wheels

Portable suction Yes

machine

Safety Box No

Sphygmomanometer Yes

(Non Mercury) and

stethoscope

Stool adjustable height No

Operating table No Yes Yes IV Therapy Equipment No

Anesthesia Equipment No

Anesthetic

trolleyormachine

CO2 Monitor No

O2 Monitor No Yes

Yes Yes Yes Yes

Yes Yes Yes

Yes Yes

Yes No No

Endoscopic equipment No

and necessary

accessories

Bronchoscope No No Desirable

Colonoscope No

Endoscope No No Desirable

No Desirable No Desirable

No No No Yes

No Yes Yes Yes

Fiber Optic No

Laryngoscope Central Supply

Amputation set No

Dilatation and No curettage set

Hernia set No Linens Yes

Caesareanorhysterecto my set

Endoscopic instrument cleaning machines

and solutions

Laparotomy set

Locked storage

Yes

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

Operating drapes

Ophthalmic instrument

Sterilization equipment for instrument and

Yes

Protective caps, aprons, shoes and gowns etc.

Yes

Pelvicorfistula repair set

Yes

Sterile gloves

Yes

linens

Surgical supplies (e.g., sutures, dressings, etc.)

Yes

Thoracocentesis set

Thoracostomy set with appropriate tubes and water seal bottles

Yes

Thoracotomy set

ThyroidorParathyroid set

Yes

Tracheostomy set

Yes

Tubal ligation set

Yes

Vascular repair set

Yes

Other equipment as per the specialized services available shall also be there

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

APPENDIX 4

DRUGS, MEDICAL DEVICES AND CONSUMABLES

Name of the Drug

INJECTIONECTIONS

INJECTION. DIAZEPAM 10 MG INJECTION. FRUSEMIDE 20 MG INJECTION. ONDANSETRON 8 MGor4ML INJECTION. RANITIDINE

INJECTION NOR ADRENALINE 4 MG INJECTION. PHENYTOIN 50 MG

INJECTION DICLOFENAC 75 MG

INJECTION. DERIPHYLLINE

INJECTION CHLORPHENIRAMINE MALEATE INJECTION. HYDROCORTISONE 100 MG INJECTION. ATROPINE 0.6 MG

INJECTION. ADRENALINE 1 MG INJECTION. KCL

STERILE WATER

INJECTION. SODA BICARBONATE INJECTION. DOPAMINE INJECTION. NALAXONE 400 MCG INJECTION. LIGNOCAINE 50 ML TAB. SORBITRATE

TAB. ASPIRIN INJECTION. TETANUS

e. List of Emergency Drugs and consumables (Essential in all hospitals)

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

INJECTION. ADENOSINE

OTHER

NEB. SALBUTAMOL2.5 ML

NEB. BUDESONIDE

LIGNOCAINE JELLY 2%

ACTIVATED CHARCOAL

CALCIUM (INJECTION or TAB)

FLUIDS

RL 500 ML

NS 500 ML

NS 250 ML

NS 100 ML

DNS 500 ML

DEXTROSE 5% 500 ML

DEXTROSE 10% 500 ML

PEDIATRIC IV INFUSION SOLUTION 500 ML

f. The other drugs and consumables shall be available as per the scope of services, bed strength and patient turnover.

g. Medical devices shall be available as per the scope of services, bed strength and patient turnover.

Clinical Establishments Act Standards for Hospital (LEVEL 2)

APPENDIX 5

HUMAN RESOURCE

The Human Resource requirement for any hospital shall be as per the scope of services provided by the hospital.

The requirement mentioned below is the minimum requirement for upto 50 bedded Hospital Level 2 and it shall be prorated as required:

CEA orHospital- 002

Human Resource

Requirement

Doctor

MBBS doctor shall be available round the clock on site per unit.

Availability of specialist as per the Minimum standards of that specialty.

Nurses

Qualified nurses per unit per shift shall be available as per requirement laid down by “The Indian Nursing Council, 1985”, occupancy rate and distribution of bed.

Pharmacist (If in house pharmacy available)

1 in a hospital

Lab Technician (if in house laboratory service available)

1 in a hospital (minimum DMLT)

X-ray Technician (if in house X-ray facility available)

1 in a hospital (minimum Diploma in X Ray Technician course)

Multi-purpose Worker

Minimum 2

*Requirement of other staff (support and administrative) will depend on the scope of the hospital.

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

APPENDIX6

LIST OF LEGAL REQUIREMENTS

Below is the list of legal requirements to be complied with by a hospital as applicable by the localorstate health authority (all may not be applicable):

Sl.

Name of Document

Valid From

Valid Send for Till renewal

Remark

(Expiredor validorNA)

Registration under Nursing Home Actor Medical Establishment Act

Bio-medical Waste Management Licenses

Authorization of HCO by PCB

MOU with Vendor

AERB Licenses

NOC from Fire Department

Ambulance

Commercial Vehicle Permit

Commercial Driver License

Pollution Control Licenses

Building Completion Licenses

Lift license for each lift

DG Set Approval for Commissioning

Diesel Storage Licenses

10.

Retail and bulk drug license (pharmacy)

11.

Food Safety Licenses

12.

Narcotic Drug Licenses

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

13.

Medical Gases Licensesor Explosives Act

14.

Clinical Establishments and Registration (if applicable)

15.

Blood Bank Licenses

16.

MoU or agreement with outsourced human resource agencies as per labor laws

17.

Spirit Licence

18.

Electricity rules

19.

Provident fundorESI Act

20.

MTP Act

21.

PNDT Act

22.

Sales Tax registration

23.

PAN

24.

No objection certificate under Pollution Control Act (AirorWater)

25.

Wireless operation certificate from Indian P&T

26.

Arms Act, 1950 (if guards have weapons)

Clinical Establishments Act Standards for Hospital (LEVEL 2)

APPENDIX 7 CONTENT OF MEDICAL RECORD

Medical record shall contain, at the least, the following information:

CEA orHospital- 002

Content

Name & Registration number of treating doctor

Name, demographic details & contact number of patient

Relevant Clinical history, Assessment and re-assessment findings, nursing notes and Diagnosis

Investigation reports

Details of medical treatment, invasive procedures, surgery and other care provided

Applicable consents

Discharge summary

Cause-of-death certificate & Death Summary (where applicable)

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

APPENDIX 8 Patients’ rights and responsibilities:

A patient and hisorher representative has the following rights with respect to the clinical establishment-

60. To adequate relevant information about the nature, cause of illness, proposed investigations and care, expected results of treatment, possible complications and expected costs;

61. Rate of services provided by the clinical establishment would be displayed prominently.

62. To access a copy of case papers, patient records, investigations reports and detailed bill

63. To informed consent prior to specific testsortreatment (e.g. surgery, chemotherapy)

64. To seek second opinion from an appropriate clinician of patients’ choice, with records and information being provided by treating hospital

65. To confidentiality, human dignity and privacy during treatment.

66. To have ensured presence of a female person, during physical examination of

a female patient by a male practitioner

67. To non-discrimination about treatment and behaviour on the basis of HIV

status

68. To choose alternative treatment if options are available

69. Rate of services provided by the clinical establishment would be displayed

prominently.

Provide all health related information

Cooperate with Doctors during examination, treatment

Follow all instructions

Pay hospitals agreed fees on time

Respect dignity of doctors and other hospital staff

Never resort to violence

Patients’ Rights

Patients’ Responsibilities

Clinical Establishments Act Standards for Hospital (LEVEL 2)

CEA orHospital- 002

APPENDIX 9

INFORMED CONSENTorCONSENT GUIDELINES

The informed consent shall at the least contain the following information in an understandable language and format(desirably which a lay person can easily understand)

Content

Name of the patientor guardian (in case of minorormentally disabled).

Registration number of patient

Date of admission

Name & Registration number of treating doctor

Name of procedureoroperationorinvestigationorblood transfusionoranaesthesiaor potential complications

Signature of patientorguardian with date and time

Clinical Establishments Act Standards for Hospital (LEVEL 2)

APPENDIX 10 Discharge Summary

The discharge summary shall at the least contain the following information in an understandable language and format.

CEA orHospital- 002

Sl. No.

Content

Name & Registration number of treating doctor

Name, demographic details & contact number of patient, if available

Date of admission and discharge

Relevant clinical history, assessment findings and diagnosis

Investigation results,

Details of medical treatment, invasive procedures, surgery and other care provided

Discharge advice (medications and other instructions).

Instruction about when and how to obtain urgent care.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Clinical Establishment Act Standard for

HOSPITAL (LEVEL 3) Standard No. CEA or Hospital – 003

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Table of Contents

Particulars

Page No.

Categorization of Hospitals

4-5

Definition

6-8

Scope

8-9

Infrastructure

8-9

Equipments

Human Resource

LegalorStatutory Requirements

Record Maintenance and Reporting

11-12

Basic Processes

12-14

Appendix 1

15-19

Appendix 2

Appendix 3

21-26

Appendix 4

27-28

Appendix 5

29-30

Appendix 6

31-32

Appendix 7

33-38

Appendix 8

Appendix 9

Appendix 10

Appendix 11

References

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Categorization of Hospitals

The minimum standards for Allopathic hospitals Under Clinical Establishment Act, 2010 are developed on the basis of level of care provided, as defined below:

Hospital Level 1 (A)-

General Medical services with indoor admission facility provided by recognized allopathic medical graduate(s) and may also include general dentistry services provided by recognized BDS graduates.

Example: PHC, Government and Private Hospitals and Nursing Homes run by MBBS Doctors etc.

Hospital Level 1(B) –

Level 1(A) and Level 1(B) Hospitals shall also include support systems required for the respective services like Pharmacy, Laboratory, etc.

Example: General Hospital, Singleor Multiple basic medical Specialties provided at Community Health Centre, Sub Divisional Hospital, and Private Hospital of similar scope, Nursing Home, Civil or District Hospital in few places etc.

Hospital Level 2 (Non-Teaching)

This level may include all the services provided at level 1(A) and 1(B) and services through other medical specialties given as under ,in addition to basic medical specialty given under 1(B) like:

1. Orthopaedics 2. ENT

3. Ophthalmology 4. Dental

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

5. Emergency with or without ICU

6. Anaesthesia

7. Psychiatry

8. Skin

9. Pulmonary Medicine

10. Rehabilitation, etc.

And support systems required for the above services like Pharmacy, Laboratory, Imaging facilities, Operation Theatre etc.

Example: District Hospital, Corporate Hospitals, Referral Hospital, Regionalor State Hospital, Nursing Home and Private Hospital of similar scope etc.

Hospital Level 3 (Non-Teaching) Super-specialty services –

Example: Corporate Hospitals, Referral Hospital, RegionalorState Hospital, Nursing Home and Private Hospital of similar scope etc.

Hospital Level 4 (Teaching) –

This level will include all the services provided at level 2 and may also have Level 3 facilities. It will however have the distinction of being teaching or training institution and it may or may not have super specialties. Tertiary healthcare services at this level can be provided through specialists and may be super specialists (if available). It will have other support systems required for these services. It shall also include the requirement of MCIorother registering body for teaching hospitals and will be governed by their rules. However registration of teaching Hospitals will also be required under Clinical Establishment Act for purpose other than those covered under MCI such as, records maintenance and reporting of information and statistics, and compliance to range of rates for Medical and Surgical procedures, etc.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Clinical Establishment Act Standards for Hospital (LEVEL 3)

31. Definition

The general hospital, may have multiple departments taking care of many kinds of disease and Injectionury, and normally has an emergency department to deal with immediate and urgent care.

A hospital can be situated in rural or urban setting. It can be run by Public Sector (Central government or State government or Local government or Public Sector undertaking or Registered Society etc) or by Private Sector (Individual Proprietorshipor Registered Partnership or Registered Company or Co-operative Society or Trust or Charitable etc).

Hospital Level 3 (Non-Teaching) Super-specialty services –

These hospitals may provide following specialized services Cardiology, Cardiothoracic surgery, Neurology, Neurosurgery, Nephrology, Joint replacement, Plastic and reconstructive surgery, Rheumatology, Endocrinology, Respiratory Medicine, Oncology,

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Nuclear Medicine, Paediatric Surgery, Gastroenterology, GI surgery, Transplantation Services, Blood Storage Centre or Blood Bank etc.

Example: Corporate Hospitals, Referral Hospital, RegionalorState Hospital, Nursing Home and Private Hospital of similar scope etc.

32. Scope

The scope of services that may be provided at a hospital level 3 practising Allopathy – Modern system of Medicine may include patient-care services in any or all of the following specialities, but not necessarily limited to:

Clinical Services:

2.1. General Medicine

2.2. General Surgery

2.3. Obstetrics and Gynaecology

2.4. Fertility and Assisted Reproduction

2.5. Paediatrics

2.6. Paediatric Intensive Care

2.7. Paediatric surgery

2.8. Neonatology

2.9. Orthopaedics

2.10. Orthopaedics with Joint Replacement

2.11. Anaesthesiology

2.12. Emergency Medicine & Trauma

2.13. Critical Care Medicine (e.g. HDU, ICU)

2.14. ENT

2.15. Ophthalmology

2.16. Neurology

2.17. Neurosurgery

2.18. Cardiology

2.19. Cardiothoracic surgery

2.20. Urology

2.21. Nephrology & Dialysis

2.22. Gastroenterology

2.23. GI Surgery (Surgical Gastroenterology)

2.24. Minimally Invasive Surgery or Minimal Access Surgery

2.25. Respiratory Medicine

2.26. Endocrinology

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

2.27. Rheumatology

2.28. Clinical Immunology

2.29. Psychiatry & Mental Health

2.30. Medical Oncology

2.31. Surgical Oncology

2.32. Radiation Oncology

2.33. Nuclear Medicine

2.34. Plastic & Reconstructive Surgery

2.35. Dermatology

2.36. Community Health

2.37. Palliative Medicine

2.38. Geriatric Care

2.39. Family Medicine

2.40. Clinical Haematology

2.41. Organ transplantation

2.42. Genetics

2.43. Dentistry including sub specialities

2.44. Physical Medicine & Rehabilitation

2.45. Transfusion MedicineorBlood Storage CentreorBlood Bank

2.46. Other emerging sub-specialities in any of the above fields, or emerging

independent specialities

Support services:

33.

2.29. Registration or help desk and billing

2.30. Diagnostic Services (OwnorOutsourceorTie up):

a. Laboratory

b. Imaging Services

c. Non-imaging services e.g. Audiology Lab, TMT,

Echocardiography, Neurophysiology, Urodynamics, PFT,

Sleep Studies (Polysomnography), etc.

2.31. Pharmacy and Stores

2.32. CSSD or Sterilization Area

2.33. Linen and Laundry

2.34. Kitchen & Dietary Services

2.35. Waste Management Services (General and Biomedical)

2.36. Medical Gas Supply, Storage & Distribution

2.37. Ambulance services

Infrastructure Requirements:

3.1

Signage

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

3.1.1

The Hospital shall display appropriate signage which shall be in at least two languages

3.1.2

The building shall have a board displaying the name of the hospital at a prominent location

3.1.3

Directional signage shall be placed within the facility to guide the patient.

Following informative signage shall be displayed:

3.1.4

Name of the care provider with registration number

3.1.5

Registration details of the hospital as applicable

3.1.6

Availability of fee structure of the various services provided (refer to CEA 2010 rules & regulation).

3.1.7

Timings of the hospital and services provided

3.1.8

Mandatory information such as under PNDT Act etc. prominently as applicable.

3.1.9

Important contact numbers such as Blood Banks, Fire Department, Police and Ambulance Services available in the nearby area.

Following safety signage shall be displayed:

3.1.11

Safety Hazard and Caution signs, for e.g. hazards from electrical shock, inflammable articles, radiation etc. at appropriate places, and as applicable under law.

3.1.12

Appropriate Fire exit signage.

3.1.13

Signage for “No Smoking” in prominent places.

3.2.

Other requirements

3.2.1

Access to the hospital shall be comfortable for the patient andor or attendantsorvisitors.

3.2.2

Access shall be provided within the requirements of “Persons with Disabilities Act” and shall be easy for all those whose mobility may be restricted due to whatever cause.

3.2.3

The hospital shall be developed and maintained to provide safe, clean and hygienic environment for patients, their attendants, staff and visitors

3.2.4

The hospital shall have 24 hour provision of potable water for drinking & hand hygiene. It shall also have 24 hour supply of electricity, either through direct supply or from other sources.

3.2.5

The building shall be planned as such that sensitive areas, such as wards, consulting and treatment rooms and operation theatres are placed away from the outdoor source of noise. The hospital shall be well illuminated and ventilated

3.2.6

The hospital shall have clean public toilet(s) separate for males and females.

3.2.7

The hospital shall have mechanism for timely maintenance of the hospital building and equipment.

3.2.8

The hospital shall have appropriate internal and external communication facilities.

3.2.9

Furniture and fixtures shall be available in accordance with the activities and workload of the hospital. They shall be functional and properly maintained.

For minimum space requirements refer to Appendix 1.

For indicative list of furniture and fixtures refer to Appendix 2.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

34. Medical Equipment and Instruments:

4.1

The hospital shall have adequate medical equipment and instruments, commensurate to the scope of service and number of beds.

4.2

There shall be established system for maintenance of critical equipment

4.3

All equipment shall be kept in good working condition through a process of periodic inspection, cleaning and maintenance. Advisory-Annual Maintenance. Log Book to be maintained.

For indicative list of medical equipment and instruments refer to Appendix 3.

35. Drugs, Medical devices and Consumables:

5.1

The hospital shall have adequate drugs, medical devices and consumables commensurate to the scope of services and number of beds

5.2

Emergency drugs and consumables shall be available at all times.

5.3

Drug storage shall be in a clean, well lit, and safe environment and shall be in consonance with applicable laws and regulations.

5.4

The hospital shall have defined procedures for storage, inventory management and dispensing of drugs in pharmacy and patient care areas

For indicative list of drugs, medical devices and consumables refer to Appendix 4.

36.Human Resource Requirements:

6.1

The hospital shall have qualified andoror trained medical staff as per the scope of service provided and the medical care shall be provided as per the requirements of professional and regulatory bodies.

6.2

The hospital shall have qualified andoror trained nursing staff as per the scope of service provided and the nursing care shall be provided as per the requirements of professional and regulatory bodies

6.3

The support or paramedical staff shall be qualified and or or trained as per the scope of services provided, and as per the requirement of the respective professional or regulatory bodies.

6.4

For human resource requirements refer to Appendix 5

37.Support Services:

RegistrationorHelp desk and Billing:

7.1.

The hospital shall have a Registration or Help-desk & Billing counter, and the scope of this shall also include provision of patient guidance in matters like services available, cost estimation, healthcare insurance etc.

Diagnostic Services:

7.2.

Diagnostic services may be in-house or outsourced. For minimum standards for diagnostic services refer to CEA standards for Imaging and laboratory services.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

7.3. 7.4.

Pharmacy Services 7.5.

7.6.

7.7.

7.8.

CSSD or Sterilization Area 7.9.

7.10.

Linen management: 7.11.

7.12.

Waste Management Services: 7.13.

7.14. 7.15.

Medical Gas 7.16.

7.17. 7.18. 7.19.

Ambulance services 7.20.

7.21. 7.22.

38.LegalorStatutory Requirements:

Whether in house or outsourced, the services shall fulfil the requirements of safe and timely patient care.

The diagnostic services, whether in house or outsourced, shall be commensurate with the scope of services

Pharmacy services in a hospital can be in-house or outsourced.

All applicable legal requirements shall be complied with.

Medicine storage shall be in a clean, well lit, and safe environment, and as per manufacturer’s requirements

Quality of drugs, medical devices and consumables shall be ensured

Provision for instrument and linen sterilization and storage of sterile items shall be made available as per the scope of services.

Validation of Sterilization shall be done for ensuring the effectiveness of sterilization process

Soiled linen shall be collected, transported and washed separately in clean and hygienic environment.

Where linen is contaminated, appropriate decontamination shall be carried prior to despatch for washing.

Segregation, collection, transportation, storage and disposal of biomedical waste shall be as per Bio Medical Waste Handling Rules.

Waste management guidelines shall be followed in the case of Mercury & other toxic materials as per applicable local laws.

Segregation, collection, transportation, storage and disposal of general waste shall be as per applicable local laws

Oxygen for medical use shall be available. In addition other gases like Nitrous oxide, Carbon dioxide etc. may be available in consonance with the scope of services and bed strength.

Medical gases shall be stored and handled in a safe manner.

All applicable legal requirements shall be complied with.

Appropriate back-up and safety measures shall be in place to ensure patient safety at all times.

The hospital shall have provision of transporting patients for transfer or referral or investigations etc in safe manner.

The ambulance service shall be in-house and shall comply with the applicable local laws.

Critical patient shall be transported under supervision of trained and qualified staff.

Appropriate ambulance services should be available.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

39.Record Maintenance and reporting:

8.1

Every application must be accompanied with the documents confirming compliance with local regulations and law.

For indicative list refer to Appendix 6.

9.1

The minimum medical records to be maintained and nature of information to be provided by the Hospitals shall be as prescribed in Section 12 (1) (iii) of this Act

9.2

Medical Records may be maintained in physical or digital format.

9.3

Confidentiality, security and integrity of records shall be ensured at all times

9.4

The medical records of IPD patients shall be maintained in consonance with National or local law, MCI guidelines, and court orders.

9.5

Every Hospital shall maintain health information and statistics in respect of national programmes, notifiable diseases and emergencies or disasters or epidemics and furnish the same to the district authorities in the prescribed formats and frequency.

Content of medical record shall be as per Appendix 7

40.Basic Process:

Registration or help desk and billing services

10.39.

10.40.

Once registered, depending on the clinical need, patient is guided to appropriate service area like OPD etc

10.41.

Patient shall be guided and informed regarding Patients’ rights & responsibilities, cost estimates, third party services (e.g. Insurance) etc. (Refer Appendix 8)

10.42.

The billing shall be as per the Hospital tariff list, which shall be available to patients in a suitable format.

Assessment and Plan of care

10.43.

Each patient shall undergo an initial assessment by qualified andoror trained personnel.

10.44.

10.45.

At the time of admission of patient, General Consent for admission shall be taken.

10.46.

In case of non-availability of beds or where clinical need warrants, the patient shall be referred to another facility along with the required clinical information or notes.

10.47.

Reassessments of the admitted patients shall be done at least once in a day andoror according to the clinical needs and these shall be documented.

10.48.

Any examination, treatment or management of female patient shall be done in

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Informed Consent Procedure 10.49.

Care Of Patient 10.50.

10.51. 10.52. 10.53.

10.54.

Emergency Services: 10.55.

10.56.

Medication Prescription, Administration And Monitoring 10.57.

10.58.

10.59.

10.60. 10.61.

10.62.

Infection Control 10.63.

10.64.

the presence of an employed female attendant or female nursing staff, if conducted by male personnel inside the hospital and vice versa.

Informed consent shall be obtained from the patientor next of kinor legal guardian as and when required as per the prevailing Guidelines or Rules and regulations in the language patient can understand (for e.g. before Invasive procedures, anaesthesia, Blood transfusion, HIV testing, Research, etc.). Appendix 9

The Hospital shall provide care of patient as per the best clinical practices and reference may be made to Standard Treatment Guidelines as notified on the website of Clinical Establishments Act 2010.

Patient andoror families shall be educated on preventive, curative, promotive and rehabilitative aspects of care either verbally, or through printed materials.

All the relevant documents pertaining to any invasive procedures performed shall be maintained in the record, including the procedure safety checklist.

Monitoring of patient shall be done during and after all the procedures and same shall be documented (for example, after anaesthesia, surgical procedures, blood transfusion, etc).

Staff involved in direct patient care shall receive basic training in CPR

Emergency patients shall be attended on priority. The Emergency department shall be well equipped with trained staff.

If emergency services are not available in the hospital, the hospital shall provide first aid to the patients and arrange appropriate transferorreferral of the patient.

Prescription shall include name of the patient, date, name of medication, dosage, route, frequency, duration, name, signature and registration number of the medical practitioner in legible writing

Drug allergies shall be ascertained before prescribing and administration; if any allergy is discovered, the same shall be communicated to the patient and recorded in the Case sheet as well.

Patient identity, medication, dose, route, timing, expiry date shall be verified prior to administration of medication

Safe Injectionection practices shall be followed as per WHO guidelines.

High Risk Medicines shall be identified and verified by two trained healthcare personnel before administration.

Patients shall be monitored after medication administration and adverse drug reaction or events if any shall be recorded and reported.

The hospital shall follow standard precautions like practicing hand hygiene, use of personal protection equipment etc. to reduce the risk of healthcare associated infections.

10.65

The hospital shall ensure adequate and proper spacing in the patient care area so as to prevent transmission of infections.

Regular cleaning of all areas with disinfectant shall be done as per prescribed &

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

documented procedure.

10.66.

Prescribed & documented Infection Control Practices shall be followed in High risk areas like Operation theatre, ICU, HDU, etc as per good clinical practice guidelines.

10.67.

Housekeeping or sanitary services shall ensure appropriate hygiene and sanitation in the hospital.

Safety of the patient, staff, visitors and relative in a hospital

10.68.

10.69.

The Hospital shall undertake all necessary measures, including demonstration of preparedness for fire and non-fire emergencies, to ensure the safety of patients, attendants, staff and visitors.

10.70.

10.71.

Patient Information and Education

10.72.

The patient and oror family members are explained about the disease condition, proposed care, including the risks, alternatives and benefits. They shall be informed regarding the expected cost of the treatment. They shall also be informed about the progress and any change of condition.

10.73.

Patient and or or family shall be educated about the safe and effective use of medication, food drug interaction, diet, and disease prevention strategies.

Discharge

10.74.

A Discharge summary shall be given to all patients discharged from the hospital. For content of discharge summary refer to Appendix 10.

10.75.

The discharge summary shall include the points as mentioned in the Appendix in an understandable language and format

10.76.

Discharge summary shall also be given to patient andoror attendant in case of transfer LAMAorDAMA or death.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

APPENDIX 1

Minimum space requirements in a hospital level 3 shall be as follows:

Area (Desirable)

Wards

Ward bed and surrounding space

6 sq mor bed; in addition circulation space of 30% as indicated in total area shall be provided for nursing station, ward store, sanitary etc.

Intensive Care Unit

For ICUorCCUorNeurology ICUorHDUorTrauma ICUorRenal ICU bed and surrounding space

10.5 sq mor bed; in addition circulation space of 30% as indicated in the total area shall be provided for nursing station, doctors’ duty room, store, clean and dirty utility, circulating area for movement of staff, trolley, toilet etc.

Minor Operation TheatreorProcedure room

OT for minor procedures

10.5 sq m; in addition circulation space of 30% as indicated in total area shall be provided for nursing station, scrub station, clean and dirty utility, dressing room, toilet etc.

Labour room

Labour Table and surrounding space

10.5 sq mor labour table

Other areas- nursing station, doctors’ duty room, store, Clean and dirty utility, Circulating area, Toilets

10.5 sq m for clean utility and store and 7 sq m for dirty utility and 3.5 sq m for toilet.

Operation Theatre (OT)

Operating Room Area

30.5 sq m per operating room.

Emergency & Casualty (if separate):

Emergency bed and surrounding space

10.5 sq mor bed: in addition circulation space of 30% as indicated in total area shall be provided for nurse station, doctor duty room store, clean and dirty utility, dressing area, toilet etc.

Pharmacy (Own or Outsourced)

Pharmacy

The size should be adequate to contain 5 percent of the total clinical visits to the OPD in one session at the rate of 0.8 m2 per patient.

Bio-medical Waste

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Other requirements:

Wards:

6. The ward shall also have designated areas for nursing station, doctors’ duty room, store, clean and dirty utility, janitor room, toilets and this shall be provided from circulation area.

7. For a general ward of 12 beds, a minimum of 1 WC and 1 hand wash basin shall be provided.

8. Distance between beds shall be 1.0 metres

9. Space at the head end of bed shall be 0.25 metres.

10. Door width shall be 1.2 metres and corridor width 2.5 metres

Intensive Care Unit:

7. The unit is to be situated in close proximity of operation theatre, acute care medical and surgical ward units.

8. Suction, oxygen supply and compressed air to be provided for each bed.

9. Adequate lighting and uninterrupted power supply shall be provided.

10. Adequate multi-sockets with 5 ampere and 15 ampere sockets and or or as per requirement to be provided for each bed.

11. Nurse call system for each bed is desirable.

12. ICU shall have designated area for nursing station, doctors’ duty room, store, clean and dirty utility, circulating area for movement of staff, trolley, toilet, shoe change, trolley bay, janitor closet etc.

Labour room:

16. The obstetrical unit shall provide privacy, prevent unrelated traffic through the unit and provide reasonable protection of mothers from infection and from cross-infection.

<50 beds

5 sq m

10.

50-100 beds

10 sq m

11.

>100 beds

20 sq m

Other functional areas (laboratory, diagnostics, front officeorreception, waiting area, administrative area etc) should be appropriately sized as per the scope of service and patient load of the hospital.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

17. Measures shall be in place to ensure safety and security of neonates.

18. Resuscitation facilities for neonates shall be provided within the obstetrical unit and convenient to the delivery room.

19. The labour room shall contain facilities for medication, hand washing, charting, and storage for supplies and equipment.

20. The labour room shall be equipped with oxygen and suction

Operation Theatre

10. The operation theatre complex shall have appropriate zoning.

11. The operation theatre complex shall provide appropriate space for other areas- nursing station, doctors’ duty room, scrub station, sterile store, Clean and dirty utility, Dress change room, Toilets. Following zoning is recommended: –

a. Sterile area – consists of operating room sterile store and anesthesia room

b. Clean zone- consists of equipment or medical store, scrub area, pre and or or post-operative area and linen bay.

c. Protective zone- consists of change room, doctors’ room and toilets.

d. Dirty area.

e. Due considerations are to be given to achieve highest degree of asepsis to

provide appropriate environment for staff and patients.

12. Doors of pre-operative and recovery room are to be 1.5 m clear widths.

13. Air Conditioning to be provided in all areas. Window AC and split units should preferably be avoided as they are pure re circulating units and become a source of infection.

14. Appropriate arrangements for air filtration to be made.

15. Temperature and humidity in the OT shall be monitored.

16. Oxygen, Nitrous Oxide, suction and compressed air supply should be provided in all OTs.

17. All necessary equipment such as shadow-less light, Boyle’s apparatus shall be available and in working condition.

18. Uninterrupted power supply to be provided.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Note: For Eye Hospitals only where procedures are done in local and oror regional anaesthesia, Minor OT criteria may be applicable.

Emergency room

26. Emergency bed and surrounding space shall have minimum 10.5 sq mor bed area.

27. There shall be designated space for nurse station, doctor duty room store, clean and dirty utility, dressing area, toilet etc.

Clinical Laboratory (own orOut sourced)

2. The laboratory area shall be appropriate for activities including test analysis, washing, biomedical waste storage and ancillary services like Storage of records, reagents, consumables, stationery etc eating area for staff.

Imaging (own orOutsourced)

5. The department shall be located at a place which is easily accessible to both OPD and wards and also to emergency and operation theatre.

6. As the department deals with high voltage, presence of moisture in the area shall be avoided.

7. The size of the department shall depend upon the type of equipment installed.

8. The departmentorroom shall have a sub-waiting area preferably with toilet facility and a change room facility, if required.

Central Sterilization and Supply

4. Department (CSSD) — Sterilization, being one of the most essential services in a hospital, requires the utmost consideration in planning.

5. Centralization increases efficiency, results in economy in the use of equipment and ensures better supervision and control.

6. The materials and equipment dealt in CSSD shall fall under three categories: a) Those related to the operation theatre department,

b) Common to operating and other departments, and

c) Pertaining to other departments alone.

Other Departments

Other departments shall have appropriate infrastructure commensurate to the scope of service of the hospital.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

APPENDIX 2 FURNITURE AND FIXTURES:

ARTICLES

Examination Table Writing tables Chairs

Almirah

Waiting Benches

MedicalorSurgical Beds

Labour Table- if applicable

Wheel ChairorStretcher

Medicine Trolley, Instrument Trolley Screensorcurtains

Foot Step

Bed Side Table

Baby Cot- if applicable

Stool

Medicine Chest

Examination Lamp

View box

Fans

Tube Lightor lighting fixtures

Wash Basin

IV Stand

Colour coded bins for BMW

*this is an indicative list and the items shall be provided as per the size of the hospital and scope of service.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

APPENDIX 3 EQUIPMENTS

g. Emergency Equipment

S.No.

Name of Emergency Equipment

Resuscitation equipment including Laryngoscope, endotracheal tubes, suction equipment, xylocaine spray, oropharyngeal and nasopharyngeal airways, Ambu Bag- Adult & Paediatric (neonatal if indicated)

Oxygen cylinders with flow meteror tubingorcatheterorface maskornasal prongs

Suction Apparatus

Defibrillator with accessories

Equipment for dressingorbandagingorsuturing

Basic diagnostic equipment- Blood Pressure Apparatus, Stethoscope,, weighing machine, thermometer(Non mercury)

ECG Machine

Pulse Oximeter

Nebulizer with accessories

h. Other equipment and consumables, which shall also be available in good working condition as per the scope of services and bed strength (some of the emergency equipment are already mentioned above).

Department

Equipment

Level 1A

Level 1B

Level 2

Level 3

NON MEDICAL

Administration

Office equipment

Yes

Office furniture

Yes

Electricity

Emergency lights

Yes

Water Supply

Hand-washing

Yes

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Waste Disposal

sinksortapsorbowls on stands in all areas Storage tank

Water purification chemicals or filter Water source for drinking water

Buckets for contaminated waste in all treatment areas Drainage system Rubbish bins in all rooms

Sanitation facilities for patients

Separate Bio-medical waste disposal Sharps containers in all treatment areas

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Desirable Desirable Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes

Safety

Fire extinguisher Vehicle (OwnorOutsourced)

Vehicle wheeler Ambulance

Lockable storage

Medical Stores

Refrigeration Kitchen (OwnorOutsourced)

Cooking pots and utensils

Cooking stove

Food refrigeration Plates, cups & cutlery

Storage

Washing and drying area facilities

Laundry (OwnorOutsourced) Detergentorsoap

Washing and rinsing equipmentorbowls

Yes

Housekeeping Brooms, brushes and

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

mops

Housekeeping (OwnorOutsourced)

Outpatient Rooms

MEDICAL

Yes Yes

Yes

Yes Yes Yes Yes

Yes Yes

Buckets

Soap and disinfectant

Yes

Non Mercury Blood Pressure Apparatus and stethoscope

Yes Yes

Yes

Yes Yes Yes Yes

Yes Yes

Container for sharps disposal

Yes Yes

Desk and chairs

Yes Yes

Examination gloves

Yes Yes

Examination table

Yes Yes

Hand washing facilities

Minor surgical instruments

Yes Yes

Light source

Yes Yes

No Yes

Ophthalmoscope

No No

Otoscope

No No

Patellar hammer

Separate biohazard disposal

Thermometer (Non mercury)

Yes Yes

Receptacle for soiled pads, dressings, etc.

Yes Yes

Sterile equipment storage

Yes Yes

Sutures

Yes Yes

Torch with extra batteries

Yes Yes

Weighing scale

Yes Yes

Women and Child health examination room

Yes (as Yes applicabl

Yes Yes Yes Yes

Yes Yes

Non Mercury Blood Pressure Apparatus and stethoscope

Yes

Contraceptive supplies

Birth register

Yes Yes

Yes

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Examination gloves Yes Yes

Examination table with Yes Yes Yes Yes stirrups

Fetal stethoscope No Yes

Doppler No No No Yes

Yes Yes

Hand washing facility Yes Yes

Height measure Yes Yes Yes Yes

Yes Yes

IUD insertion set Yes Yes

Pregnant woman Yes Yes Yes Yes Register

Speculum and vaginal Yes Yes

examination kit

Syringes and needles Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes

Tape measure Yes Yes

Tococardiograph No Yes Yes Yes

Labour room

Baby scales Yes Yes Yes Yes

Non Mercury Blood Yes Yes

Pressure Apparatus and

stethoscope

Clean delivery kits and Yes Yes Yes Yes cord ties

Yes Yes

Curtains if more Yes Yes than one bed

Delivery bed and bed Yes Yes linen

Yes Yes Yes Yes Yes Yes

Fetal stethoscope Yes Yes

Hand washing facility Yes Yes Yes Yes

Instrument trolley Yes Yes

Latex gloves and Yes Yes protective clothing

Mucus extractor Yes Yes

Oxygen Yes Yes cylinderor

concentrator

Self inflating bag and Yes Yes mask – adult and

neonatal size

Suturing sets Yes Yes

Yes Yes Yes Yes

Yes Yes

IV treatment sets

Yes

Linens for newborns Yes Yes

Yes

Oral airways, various sizes

Yes

Partograph charts

Suction machine

Thermometer (Non

Yes

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Inpatient Wards

Yes Yes

Yes Yes Yes Yes

Yes Yes

Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes

Yes Yes

Yes Yes Yes Yes

Yes Yes

Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes

Operation Theatre

If available

Yes Yes Yes Yes Yes Yes

Yes Yes Yes No Yes

No Yes Yes Yes Yes

mercury)

Tray with routine & emergency drugs, syringes and needles

Urinary catheters and collection bags

Vacuum extractor set

Work surface near bed for newborn resuscitation

Basic examination equipment (stethoscope, Non mercury BP Apparatus (etc)

Beds, washable mattresses and linen

Curtains

Dressing sets

Dressing trolleyor Medicine trolley

Gloves

IV stands

Medicine storage cabinet

Oxygen cylinder and concentrator

Patient trolley on wheels

PPE kits

Suction machine

Urinals and bedpans

Adequate storage

Yes

Ambu resuscitation set with adult and child masks

Yes

Defibrillator

Electro cautery

Yes

Fixed operating lights

Fixed suction machine

Hand washing facilities

Yes

Instrument tray

Yes

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Yes

Yes (as applicabl e)

Yes

Yes Yes

Yes

Yes Yes No

Desirable Desirable

Desirable No

Yes

Yes (as applicable )

Yes

Yes Yes

Yes

Yes Yes Yes

Yes Yes

Yes Yes Yes

Yes

Instrument trolley

Yes Yes

Laryngoscope set

Mayo Stand

Yes Yes

Mobile operating light

Yes Yes

Ophthalmic Operating Microscope

No No

Oral airways, various sizes

No No

Oxygen cylinder and concentrator

Yes Yes

Patient trolley on wheels

Yes Yes

Portable suction machine

Yes Yes

Safety Box

Sphygmomanometer (Non Mercury) and stethoscope

Yes Yes

Stool adjustable height

No Yes

Operating table

No Yes

IV Therapy Equipment

Anesthesia Equipment Anesthetic trolleyor machine

No Yes

CO2 Monitor

No No

O2 Monitor

No No

Endoscopic equipment and necessary accessories

No No

Bronchoscope

No No

Colonoscope

No No

Endoscope

Desirable

Yes

Fiber Optic Laryngoscope

No No

Central Supply

Amputation set

No No

Caesareanor hysterectomy set

Endoscopic instrument cleaning machines

and solutions

Yes

Dilatation and curettage set

No No

Yes

Hernia set

No No

Laparotomy set

Yes

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

Linens

Yes

Locked storage

Yes

Operating drapes

Yes

Ophthalmic instrument

Yes

Protective caps, aprons, shoes and gowns etc.

Yes

Pelvicor fistula repair set

Yes

Sterile gloves

Yes

Sterilization equipment for instrument and linens

Yes

Surgical supplies (e.g., sutures, dressings, etc.)

Yes

Thoracocentesis set

Yes

Thoracostomy set with appropriate tubes and water seal bottles

Yes

Thoracotomy set

Yes

Thyroidor Parathyroid set

Yes

Tracheostomy set

Yes

Tubal ligation set

Yes

Vascular repair set

Yes

Other equipment as per the specialized services available shall also be there

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

APPENDIX 4

DRUGS, MEDICAL DEVICES AND CONSUMABLES

Name of the Drug

INJECTIONECTIONS

INJECTION. DIAZEPAM 10 MG INJECTION. FRUSEMIDE 20 MG INJECTION. ONDANSETRON 8 MGor4ML INJECTION. RANITIDINE

INJECTION NOR ADRENALINE 4 MG INJECTION. PHENYTOIN 50 MG

INJECTION DICLOFENAC 75 MG

INJECTION. DERIPHYLLINE

INJECTION CHLORPHENIRAMINE MALEATE INJECTION. HYDROCORTISONE 100 MG INJECTION. ATROPINE 0.6 MG

INJECTION. ADRENALINE 1 MG INJECTION. KCL

STERILE WATER

INJECTION. SODA BICARBONATE INJECTION. DOPAMINE INJECTION. NALAXONE 400 MCG INJECTION. LIGNOCAINE 50 ML TAB. SORBITRATE

TAB. ASPIRIN INJECTION. TETANUS

h. List of Emergency Drugs and consumables (Essential in all hospitals)

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

INJECTION. ADENOSINE

OTHER

NEB. SALBUTAMOL2.5 ML

NEB. BUDESONIDE

LIGNOCAINE JELLY 2%

ACTIVATED CHARCOAL

CALCIUM (INJECTION or TAB)

FLUIDS

RL 500 ML

NS 500 ML

NS 250 ML

NS 100 ML

DNS 500 ML

DEXTROSE 5% 500 ML

DEXTROSE 10% 500 ML

PEDIATRIC IV INFUSION SOLUTION 500 ML

i. The other drugs and consumables shall be available as per the scope of services, bed strength and patient turnover.

j. Medical devices shall be available as per the scope of services, bed strength and patient turnover.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

APPENDIX 5

HUMAN RESOURCE

The Human Resource requirement for any hospital shall be as per the scope of services provided by the hospital.

The requirement mentioned below is the minimum requirement for a multispecialty hospital with less than 50 beds and it can be prorated as required.

Based on the levels of care provided, the minimum staffing requirements for Hospital level 3 shall be as follows:

Human Resource

Requirement

Doctor

MBBS doctor shall be available round the clock on site per unit

Availability of specialist and super specialist as per the Minimum standards of that specialty.

In ICU, 1 MBBS for every 6 beds, on- site for 24X7

Nurses

Qualified nurses per unit per shift shall be available as per requirement laid down by “The Indian Nursing Council, 1985”, occupancy rate and distribution of bed.

Pharmacist

2 in a hospital

Lab Technician

2 in a hospital (minimum DMLT)

X-ray Technician

2 in a hospital (minimum Diploma in X Ray Technician course)

Other Technicians

As per requirement

Nutritionist

As per requirement

Social worker

As per requirement

Administrative Assistant

As per requirement

Medical Record Technician

As per requirement

Driver

As per requirement

Security Guard

As per requirement

Multi-purpose Worker

Minimum 2 (minimum 12th pass)

Requirement of other staff (Support and administrative) will depend on the scope of the hospital.

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

APPENDIX 6

LIST OF LEGAL REQUIREMENTS

Below is the list of legal requirements to be complied with by a hospital as applicable by the localorstate health authority (all may not be applicable):

Sl.

Name of Document

Valid From

Valid Till

Send for renewal by

Remark

(Expiredor validorNA)

Registration under Nursing Home Actor Medical Establishment Act

Bio-medical Waste Management Licenses

Authorization of HCO by PCB

MOU with Vendor

AERB Licenses

Type approval

Layout Approval

License for CT- interventionalor Registration for other machines

NOC from Fire Department

Ambulance

Commercial Vehicle Permit

Commercial Driver License

Pollution Control Licenses

Building Completion Licenses

Lift licenses for each lift

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

9. 10.

11. 12. 13.

14.

15. 16.

17. 18. 19. 20. 21. 22.

23. 24. 25.

26. 27.

DG Set Approval for Commissioning

Diesel Storage Licenses

Retail and bulk drug license (pharmacy)

Food Safety Licenses

Narcotic Drug Licenses

Medical Gases Licensesor Explosives Act

Clinical Establishments and Registration (if applicable)

Blood Bank Licenses

MoU or agreement with outsourced human resource agencies as per labor laws

Spirit License

Electricity rules

Provident fundorESI Act

MTP Act

PNDT Act

Transplantation of Human organs Act

Sales Tax registration

PAN

No objection certificate under Pollution Control Act (AirorWater)

Wireless operation certificate from Indian P&T

Arms Act, 1950 (if guards have

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

APPENDIX 7 CONTENT OF MEDICAL RECORD

Medical record shall contain, at the least, the following information:

weapons)

Content

Name & Registration number of treating doctor

Name, demographic details & contact number of patient

Relevant Clinical history, Assessment and re-assessment findings, nursing notes and Diagnosis

Investigation reports

Details of medical treatment, invasive procedures, surgery and other care provided

Applicable consents

Discharge summary

Cause-of-death certificate & Death Summary (where applicable)

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

APPENDIX 8 Patients’ rights and responsibilities:

A patient and hisorher representative has the following rights with respect to the clinical establishment-

70. To adequate relevant information about the nature, cause of illness, proposed investigations and care, expected results of treatment, possible complications and expected costs;

71. Rate of services provided by the clinical establishment would be displayed prominently.

72. To access a copy of case papers, patient records, investigations reports and detailed bill

73.To informed consent prior specific testsortreatment (e.g. surgery, chemotherapy)

74. To seek second opinion from an appropriate clinician of patients’ choice, with records and information being provided by treating hospital

75. To confidentiality, human dignity and privacy during treatment.

76. To have ensured presence of a female person, during physical examination of

a female patient by a male practitioner

77. To non-discrimination about treatment and behaviour on the basis of HIV

status

78. To choose alternative treatment if options are available

79. Rate of services provided by the clinical establishment would be displayed

prominently.

Provide all health related information

Cooperate with Doctors during examination, treatment

Follow all instructions

Pay hospitals agreed fees on time

Respect dignity of doctors and other hospital staff

Never resort to violence

Patients’ Rights

Patients’ Responsibilities

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

APPENDIX 9

INFORMED CONSENTorCONSENT GUIDELINES

The informed consent shall at the least contain the following information in an understandable language and format.

Content

Name of the patientor guardian (in case of minorormentally disabled).

Registration number of patient

Date of admission

Name & Registration number of treating doctor

Name of procedureoroperationorinvestigationorblood transfusionoranaesthesiaor potential complications

Signature of patientorguardian with date and time

Clinical Establishment Act Standards for Hospital (LEVEL 3)

CEAorHospital- 003

APPENDIX 10 DISCHARGE SUMMARY

The discharge summary shall at the least contain the following information in an understandable language and format.

Content

Name & Registration number of treating doctor

Name, demographic details & contact number of patient, if available

Date of admission and discharge

Relevant clinical history, assessment findings and diagnosis

Investigation results,

Details of medical treatment, invasive procedures, surgery and other care provided

Discharge advice (medications and other instructions).

Instruction about when and how to obtain urgent care.

Clinical Establishment Act Standards for Dental Laboratory

CEA orDental Lab

Clinical Establishment Act Standard for

Dental Lab Standard No.CEA or Dental Lab

Clinical Establishment Act Standards for Dental Laboratory

MINIMUM STANDARDS FOR DENTAL LABORATORY

CEA orDental Lab

DEFINITION Dental laboratory

SCOPE of SERVICES PROVIDED

Will provide laboratory work pertaining to different specialities of dentistry

PHYSICAL INFRASTRUCTURE

1 Walls shall be painted with proper quality paint with no sharp edges; floors shall be made of easily washable material e.g. ceramic tiles.

2 Proper day lighting and ventilation within the laboratory

3 Specified place to mould the metal (specially Crowns, bridges, chrome cobalt) and shall include the following machines:

Casting machine for casting all dental alloy

Preheating furnace.

Wax elimination furnace.

Soldering unit.

4 Specific place to mould ceramics that is isolated from the Laboratory other parts and dust protection (ante-dust). Shall include the following machines:

Porcelain furnace

Ultra sonic unit

5 Specified place for polishing process that includes the following:

Polishing unit for dry and wet polish.

Electrolytic polishing unit.

High-speed grinder.

6 Specified place that includes the following:

Polymerization unit.

Flask press.

Boil – out unit

7 Specified place for Models that includes the following:

Model trimmer (single or double disc).

Vibrator.

Plaster dispenser.

Model duplicate unit

8 Staff room or area

9 Store to keep the Laboratory materials

10 Aroomforthetechnicalincharge(optional)

11 Generalsafetyandsecurityconditionstobeprovidedinthebuildingandfirefighthoses

12 Dedicated area for storing records

OUTSIDE SIGNAGES

name of the dental laboratory

INSIDE SIGNAGES

Name of laboratory technician

working hours

Services provided

Charges of the services offered

INFRASTRUCTURE CONSIDERATIONS

• floors and walls – these must be non-porous, without carpets, smooth and easily cleaned

Clinical Establishment Act Standards for Dental Laboratory

CEA orDental Lab

• Lighting:

Provide a proper lighting for the working tables and working area and natural lighting for the ceramics room area to differentiate the ceramics colours.

Working table requirements and specifications:

1 A hard stone surface

2 Bench with light

3 Suction unit for dust extraction.

4 Drawers

5 Hand piece and controller

6 Bunsen burner

7 Laboratory chairs

WATER DRAINAGE

1 Water drainage system shall be wide enough to allow easy passage of water and be clean

2 Special filters shall be placed under the basins to collect all dirt and left over of plaster so as to prevent it from going through the drainage system

VENTILATION:

1 Providing suctioning fans to refine the atmosphere

2 Premises provided with special suctions placed above the thermal ovens to suck the

ascending vapours and gases out of the ovens

3 Dental laboratory technicians work in clean, well-lighted, and well-ventilated areas. Technicians can have their own workbenches, which can be equipped with Bunsen burners, grinding and polishing equipment, and hand instruments, such as wax spatulas and wax carvers.

SAFETY CONDITIONS:

1 Make the Emergency Exits in the building free of obstacles

2 Providing fire-extinguisher

3 Laboratory floor shall be made of anti-fire ceramics

4 Provide the Laboratory with fire alarms

HUMAN RESOURCES

TECHNICAL STAFF

2. LABORATORY TECHNICIAN registered with the dental council of India.

NON TECHNICAL STAFF

GRADE IV staff employed full timeorpart timeoroutsourced.

Periodic health check up, vaccination of staff

Once in a year health check up of all the staff.

Mandatory hepatitis B vaccination of the staff.

Clinical Establishment Act Standards for Dental Laboratory

CEA orDental Lab

EQUIPMENT (FUNCTIONAL)

10. Hand piece and controller

11. Bunsen burner

12. Casting machine for casting all

dental alloy

13. Preheating furnace.

14. Wax elimination furnace.

15. Soldering torch

16. Porcelain furnace

17. Ultra sonic unit

18. Polishing unit for dry and wet

polish.

19. Electrolytic polishing unit.

20. High-speed grinder.

21. Polymerization unit.

22. Flask press.

23. Boil – out unit

24. Model trimmer (single or double

disc).

25. Vibrator.

26. Plaster dispenser.

27. Model duplicate unit

28. Consumables- should be available

in adequate number.

Facemask

Gloves

Dental plaster

Dental stone

Die stone

Modelling wax

Impression compound

Sticky wax

Anatomic ,semianatomic

and flat denture teeth

Cold cure resin powder

and liquid

Heat cure resin powder

and liquid

Self cure and light cure

composite resin

Stainless steel wires-19

gauge to 23 gauge

Soldering flux

QUANTITY 1

SUPPORT SERVICES

BMW MANAGEMENT

Segregation of waste should be done in black, yellow, red and blue bags. It is mandatory to segregate the waste at the site of waste generation.

Contract for disposal of BMW should be

Clinical Establishment Act Standards for Dental Laboratory

CEA orDental Lab

given to government environmentorCPCB.

a company approved by of Indiaor ministry of

There should be a written contract for BMW management along with the economy involved.

Logbook should be maintained mentioning weight of the waste(infected) and date on which waste (neworold) was lifted.

RECORD MAINTENANCE AND REPORTING

Daily record keeping for mentioning lab work rendered along with charges.

STANDARDS ON BASIC PROCESSESES

INFECTION CONTROL

There must be good supply of clean water, through a quality piping that support good

water hygiene

All general purpose cleaning equipment and agents should be stored in a separate part of

the premises

There must be a specific space (not less than 1.5 sq. meter) for cleaning and sterilisation

of dental instruments and should not be used other than above.

Use trash bin lined with commercial color coded plastic bag for the medical waste

Keep cleaning equipment always in a very clean condition before use; type of floor

sanitizing and cleaning agents must be approved for clinical use.

There should be no cotton or wool fabric curtains in dental labs.

Non-wooden storage cabinet shall be used for storing cleaning equipment and agents labcoats,gowns,facemask,glovesetc shouldbeutilized.

FACILITIES FOR HAND WASHING

Hand-washing facilities must not be combined with sinks used for other purposes, such as decontamination and instrument cleaning.

FACILITIES FOR STERILIZATION

Disinfectants- 2 percent glutaraldehyde, sodium hypochlorite, chlorhexidine etc

POLICY ON OUTSOURCED SERVICES

cleaning staff and pest control are some of the other services which can be outsourced

Clinical Establishment Act Standards for Dietetics

CEAorDietetics

Clinical Establishment Act Standard for

Dietetics

Standard No. CEA orDietetics

Clinical Establishment Act Standards for Dietetics

CEAorDietetics

Table of Contents

Sr. No.

Particulars

Page No.

Definition

Scope

Infrastructure

Equipments orInstruments

Human Resources

Record Maintenance and Reporting

Basic Process

Appendix 1

Appendix 2

10.

Appendix 3

Clinical Establishment Act Standards for Dietetics

1. Definition

CEAorDietetics

Dietary Counseling Centre

A dieteticsclinicorpolyclinicor center may be defined as a clinical establishment providing consultation to outpatients orinpatients by Dietician (s) or Clinical Nutritionist (s).

Dietary counseling provides personalized nutritional care for encouraging modification of eating habits. It may also assist in prevention or treatment of nutrition-related illnesses such as cardiovascular disease, cancer, obesity, diabetes, and hyperlipidemia. It also involves meal planning for the patient.

It can be a stand-alone unit, or a part of polyclinicorhospital.

2. Scope (as applicable)

2.1 These set of common minimum standards framed are applicable to a single practitionerormore than one Dietician or Clinical Nutritionist or a group of Dietician or Clinical Nutritionist who are themselves providing patient care services like:

a) Nutritional Assessment

b) Prescribing specific Diets, health or Nutritional Supplements

c) Health Education and Health Promotion related to nutritional aspect of health care.

3. Infrastructure Requirements

3.1. Facility

3.1.1 The physical facility shall be developed and maintained to provide safe and secure environment for patients, their families, staff and visitors.

3.1.2 The minimum space requirement for carrying out the basic functions of the facility shall be as per Appendix 1.

3.1.3 The area should be well illuminated, ventilated and clean with adequate water supply.

Clinical Establishment Act Standards for Dietetics

3.2. Signage

3.2.1 The centreorclinic shall have a prominent boardorsignage displaying the name of the clinic in local language at the gate or on the building of the clinic.

3.2.2 The following other signage shall be well displayed in the language understood by the local public in the area:

a) Name of the Clinical Nutritionist(s)

b) Fee structure of the various services

c) Timings of the clinics (For e.g.: From 8am -2pm)

d) Services provided within the facility

3.3. Furniture & Fixtures

3.3.1 Furniture and fixtures shall be available in accordance with the activities and workload of the Clinicor Polyclinic.

3.3.2 The furniture and fixtures shall be functional.For indicative list of items refer toAppendix 2. This list is indicative and not exhaustive.

4. EquipmentsorInstruments

4.1 Equipment’s shall be of adequate capacity to meet workload requirement.

4.2 All equipment shall be kept in good working condition.

4.3 Periodic inspection, cleaning, maintenance of equipment should be done. An equipment logbook should be maintained for all major equipment. For indicative list for equipmentorinstrument refer toAppendix 3. This list is indicative and not exhaustive.

5. Human Resources

CEAorDietetics

Clinical Establishment Act Standards for Dietetics

5.1 Clinical NutritionistorDietician shall have graduate or postgraduate in Food & Nutrition from a recognized instituteoruniversity as applicable.

5.2 Personnel record containing personal and professional information shall be maintained for each staff.

5.3 Periodic skill enhancementorup gradation orrefresher trainings shall be provided for all categories of the staff relevant to their job profile.

6. Record Maintenance and Reporting

6.1 The Dietary center orclinic shall have the following forms:

a) Nutritional Assessment Forms

b) Diet Charts

c) Patient education Materials

6.2 Every centreorclinic shall maintain medical records of patients treated by it and health information and statistics in respect of national programmes and furnish the same to the district authorities in form of quarterly reports.

6.3 Copies of all records and statistics shall be kept with the clinical establishment concerned for at least 3 or 5 years or in accordance with any other relevant Act in force at the time under Section 12(1) (iii) of CEA 2010).

6.4 Records shall be maintained in physical or digital format.

6.5 Confidentiality, security and integrity of records shall be maintained.

7. Basic Processes

7.1 Registration

7.1.1 Every patient visiting the dietary clinicorpolyclinic shall be registered on each visit.

7.2Assessment

CEAorDietetics

Clinical Establishment Act Standards for Dietetics

CEAorDietetics

7.2.1 Each patient shall undergo nutritional assessment and the same should be documented.

7.2.2 During assessmentorre-assessment, the patient findings shall be co-related with the nutritional advice, which includesmedications, investigations, food drug interactionsorallergies etc.

7.2.3 Prescription in form ofDiet Charts andoror Nutritional or Health Supplements based on Clinical Evaluation shall be given to patient and documented.

7.3.Clinical Records

7.3.1. A copy of OPD Records shall be maintained.

Clinical Establishment Act Standards for Dietetics

APPENDIX 1

Minimum infrastructure requirements shall be as follows (Desirable):

CEAorDietetics

LOCATION

AREA REQUIRED

REMARKS

Common area (Reception and waiting)

20 sq ft carpet area

Consultation room (ancillary area)

50 sq ft carpet area including storage

Area specified under consultation room is only for single clinic and shall be multiplied accordingly by the number of consultation chambers.

*Reception, waiting, consultation room etc shall be adequate as per the requirement and workload of the clinic.

Clinical Establishment Act Standards for Dietetics

APPENDIX 2

Furniture and Fixtures

CEAorDietetics

Articles

Table

Chairs

Computer or Lap Top with Printer facility (optional)

Storage Cabinet for records

Clinical Establishment Act Standards for Dietetics

Equipments

APPENDIX 3

CEAorDietetics

S.No.

Equipments

Body Composition Analysis Machine or BMI Machine

Height and Weight Scale or Weighing Machine

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

Clinical Establishments Act Standard for

Integrated Counselling and Testing Centre

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

Table of Contents

Page No.

Sr. No.

Particulars

1. Definition 2. Scope

3. Infrastructure

4. Human Resource

6. 7.

EquipmentorInstrumentsorConsumables

Support Service LegalorStatutory Requirements

8. Record Maintenance and Reporting

Others

Appendix 2 Appendix 3 Appendix 4 Appendix 5

References

10.

11. Appendix 1

12.

13. 14. 15.

16 Glossary

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

1. Definition:

1.1 An integrated counselling and testing centre is a place where a person is counselled and tested and checked for HIV, Tuberculosis, ANC and postnatal follow up on his own free will or as advised by a medical provider.

1.2 An ICTC shall be located in health facilities owned by the government, in the privateornot for-profit sector, in public sector organizationsorother government departments such as the Railways, Employees’ State Insurance Department (ESID), etc. and in sectors where nongovernmental organizations (NGOs) have a presence.

1.3 In the health facility, the ICTC shall be well coordinated with the Department of Medicine, Microbiology, Obstetrics and Gynecology, Pediatrics, Psychiatry, Dermatology, Preventive and Social Medicine, etc.

2. Scope

2.1 Provision of basic information on modes of transmission and prevention of HIVorAIDS, ANC for promoting behavioral change and reducing vulnerability.

2.2 Preventive health education.

2.3 Psychosocial support.

2.4 Referral and linkages.

2.5 Monitoring and supervision.

2.6 Training of existing staff.

2.7 ICTCs can be classified into two types:

a) Fixed-facility ICTCs

b) Mobile ICTCs

2.8 Fixed-facility ICTCs:

2.8.1 Fixed-facility ICTCs are those that are located within an existing health-care facilityor hospitalorcentre.

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

2.8.2 A fixed-facility ICTC can be of two types:

a) “Stand-alone”: ICTC having a full-time counsellor and laboratory technician who undertake HIV counselling and testing. Such facilities exist in medical colleges and district hospitals, and in some sub district hospitals.

b) “Facility-integrated”: ICTC which does not have full-time staff and provides HIV counselling and testing as a service along with other services. Existing staff such as the auxiliary nurse midwife (ANM)orstaff nurseorhealth visitororlaboratory technician (LT)orpharmacist are expected to undertake HIV counselling and testing. Such ICTCs will usually be established in facilities that do not have a very large client load and where it would be uneconomical to establish a stand-alone ICTC.

c) Such facilities are 24-hour PHCs as well as private sectorornot-for-profit hospitals, private laboratories, public sector organization-run hospitals or facilities, and in the NGO sector.

2.9 Mobile ICTCs

2.9.1 Mobile ICTCs is the one which take healthservices into the community.

2.9.2 A mobile ICTC is a temporary clinic with flexible working hours in hard-to-reach areas, where services are provided ranging from regular health check-up, syndromic treatment for STIorreproductive tract infection (RTI) and other minor ailments, antenatal care, immunization, as well as HIV counselling and testing services.

2.9.3 Mobile ICTCs can thus cater to a larger audience and be a more effective preventive intervention by ensuring the reach of services.

3. Infrastructure Requirements

3.1 The ICTC centre shall have all appropriate signage in at least local languages.

3.2 The building shall have sign board displaying Integrated Counselling and Testing Centre at prominent location.

3.3 NACO logo shall be used for illiterate clients to locate the ICTC.

3.1. Signage

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

3.3.1 Following informative signage shall be displayed: Registration details of the ICTC as applicable

a. Timings of the facility and services

3.3.2 Following safety signage shall be displayed: a) Appropriate fire exit signage.

b) Signage for no smoking in prominent places.

3.4 Facility Premises

3.4.1 In a facility, the ICTC shall be located in a place that is easily accessible and

visible to the public.

3.4.2 The ICTC shall consist of a counselling room and a blood collection and testing room.

3.4.3 The counselling room shall be an enclosed space, ideally 10′ X 10′ in area so that one-on-one and one-on-group counselling sessions may be undertaken in an atmosphere of privacy.

3.4.4 The blood collection room shall have an area of at least 10′ x 10′. Blood testing could be done either in the blood collection room or in the main laboratory of the facility.

3.4.5 The facility shall be developed and maintained to provide safe, clean and hygienic environment for clients, their families, staff and visitors.

3.4.6 The facility shall be well illuminated and ventilated.

3.4.7 The facility shall have provision of water and electricity through regular or alternate sources.

3.4.8 The facility shall provide appropriate privacy during provision of services.

3.4.9 The facility shall have provision for hand washing arrangements.

3.4.10 The facility shall have appropriate communication facilities like telephone, internet etc.

3.4.11 A mobile ICTC shall consist of a van with a room to conduct a general

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

examination and counseling, and a space for the collection and processing of blood samples, etc.

3.4.12 Mobile ICTC shall have a team of paramedical health-care providers (a health educatororANM, counselor and Lab Technician).

Refer Appendix 1 for norms for setting up an ICTC.

3.5 Furniture and Fixtures

3.5.1 Furniture and fixtures shall be available in accordance with the activities and

workload of the ICTC,

3.5.2 The furniture and fixtures shall be functional. For indicative list of items refer to Appendix 2 (This list is indicative and not exhaustive).

4. Human Resource Requirement

4.1 The ICTC shall have qualified andoror trained staff as per the scope of services provided.

4.2 Personnel record containing personal and professional information shall be maintained for each staff.

4.3 Periodic skill enhancementorup gradation orrefresher trainings shall be provided for all categories of the staff relevant to their job profile.

4.4 All health care staff shall be made aware of the hospital Post Exposure Prophylaxis (PEP) procedures and the name and contact information of the PEP focal pointorperson as well as the location where the PEP drugs are stored. For Human Resource requirement refer to Appendix 3.

5. EquipmentorInstrumentsorConsumables

5.1 The centre shall ensure that the minimum space, as well as equipment and communication material required for an ICTC is provided.

5.2 The centre shall ensure that blood testing is done either in the blood collection room or in the main laboratory of the facility.

5.3 The centre shall ensure that adequate equipment is available to meet the work load requirement.

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

5.4 All equipment shall be in good working condition at all times.

5.5 The centre have provision of periodic inspection, cleaning and maintenance of the equipment. An equipment log book shall be maintained for all major equipment. For indicative list of equipmentorinstrument refer to Appendix 4 (this list is indicative and not exhaustive).

5.6 The ICTC shall ensure availability of:

a) Information, education and communication (IEC) material required for an

ICTC such as flip charts, posters, etc.

b) Rapid HIV testing kits.

c) Protective kits and prophylactic drugs for post-exposure prophylaxis (PEP) for staff.

6.1. Waste Management

6.1.1 Segregation, collection, transportation, storage and disposal of biomedical waste shall be as per Bio medical waste management rules, 2016.

7. LegalorStatutory Requirements

7.1 Every application shall be accompanied with the documents confirming compliance with local regulations and law.

8. Record Maintenance and Reporting

8.1 Records shall be maintained in physical or digital format.

8.2 Confidentiality, security and integrity of records shall be maintained.

8.3 Record shall contain at least Registration number, client details like name, address, district, phone number and brief history, etc.

8.4 The minimum medical records to be maintained and nature of information to be provided by the Clinical Establishments shall be as prescribed in CEA rules of the Act.

6. Support Service

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

8.5 The centre shall maintain health information and statistics in respect of national programmes, notifiable diseases and emergenciesordisastersor

epidemics and furnish the same to the district authorities in the prescribed formats and frequency.

8.6 The centre shall have various registers maintained as per Appendix 5 (This list is indicative not exhaustive).

9. Others

9.1 Registration

9.1.1 Every clientorpatient visiting the facility shall be registered at the registration counter.

9.1.2 All the relevant records pertaining to the programme shall be maintained.

9.2 Consent and Assessment

9.2.1 Informed Consent: Informed consent shall be obtained from the client orpatientor next of kinor legal guardian as and when required as per the prevailing guidelines or rules and regulations in the language patient can understand (e.g. HIV testing).

9.2.2 Each clientorpatient shall undergo an assessment and the same shall be documented legiblyin relevant record.

9.2.3 ICTC shall ensure that each clientorpatient is provided pre-test informationorcounselling, post-test counseling and follow-up counselling in a friendly atmosphere.

9.2.4 In ICTCs which do not have a doctor such as mobile ICTCs and ICTCs located in hot spots, the counsellor is authorized to sign the counselling and testing reports after duly verifying the records. The ICTC manager shall cross-check at regular intervals the reports signed by the counsellor.

9.2.5 Records of all such assessments shall be maintained as per applicable laws.

9.3 Infection Control

9.3.1 Adherence to standard precautions shall be maintained by all staff.

9.3.2 Running tap water for hand washing of staff shall be available.

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

9.3.3 Sanitation of the toilets and hygiene of the staff shall be maintained.

Mopping of all areas with clean mops and disinfectant shall be done at least once a day.

9.3.4 Adequate amount of bleaching solution shall be available for disinfection purpose and mopping of all areas with disinfectant shall be done at least once a day.

9.3.5 Facility for syringe and needle destruction shall be available and practiced.

9.3.6 Drugs for PEP shall be made available to any staff member who is accidentally exposed to HIV in all facilities which have an ICTC as early as 2 hours and within 24 hours of the accidental exposure and not later than 72 hours.

9.3.7 The facility shall have an assigned PEP focal pointorperson.

10. References

10.1 Operational Guidelines for Integrated Counseling and Testing Centres, July 2007, National Aids Control Organization, Ministry of Health and Family welfare, Government of India and its amendments if any.

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

Norms for Setting up an ICTC

1. Government health sector

Appendix 1

An ICTC can be set up in any government health facility such as a medical college, district hospital, sub-district hospital, community health centre (CHC) or a 24-hour primary health centre (PHC) which caters to a population of 30,000– 40,000 and has:

a) a minimum of 30 beds,

b) >50 deliveries in a month, or

c) a TB microscopy centre.

2. Privateornot-for-profit sector

ICTCs can be set up in the privateornot-for-profit sector in a facility which meets any of the criteria given below:

a) Maternity homesorhospitals with >50 deliveries in a month in “A” and “B” category

b) Districts and >100 deliveries in a month in “C” and “D” category districts;

c) Hospitalsorclinics which treat >100 TB patients in a month;

d) Hospitalsorclinics which have a case load of >100 sexually transmitted infections (STIs) in a month;

e) Diagnostic laboratories which perform >150 diagnostic HIV tests in a month;

f) Industrial zones that employ a large number of people, particularly migrantsorcasual

g) Labour on an informalorcontractual basis.

3. Public sectororother government departments

ICTCs can be set up by public sector organizationsorother government departments.

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

Some suggested locations are:

a) Railway stations and bus terminals located at major junctions on trunk routes and

b) handle a large volume of passengers every day;

c) Central prisons with a large number of inmates;

d) Health facilities run by StateorCentral Police OrganizationsorArmed Forces;

e) Health facilities run by public sector organizations catering to large volumes of

a. migrant workers;

f) Health facilities run by public sector organizations which handle >100 deliveries in amonth or have a TB microscopy centre;

g) Public sector organizations such as those in the mining industry which employ large number of persons, particularly migrantsorcasual labour;

h) University campuses.

4. NGO sector

a) Hot spots such as dhabas, halting points on highways, markets, fairs, etc. where there is a congregation of high-risk groups and their clients;

b) TB microscopy centresorReproductive and Child Health (RCH) centres run by NGOs.

An ICTC may be located in health facilities owned by the government, in the privateornot for- profit sector, in public sector organizationsorother government departments such as the Railways, Employees’ State Insurance Department (ESID), etc. and in sectors where nongovernmental organizations (NGOs) have a presence. In the health facility, the ICTC should be well coordinated with the Department of Medicine, Microbiology, Obstetrics and Gynaecology, Paediatrics, Psychiatry, Dermatology, Preventive and Social Medicine, etc. As the HIV test is a relatively low- cost test and since the risk perception is generally low, travelling a long distance to get tested could be a strong disincentive. Therefore, it is important to ensure that facilities for counselling and testing be located as close to the people as possible. ICTCs should ideally be located such that they provide maximum access to at- riskorvulnerable populations.

4.1

ICTCs can be set up in the NGO sector in

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

Appendix 2 Furniture and Fixtures

The minimum requirement of furniture for a counselling room in an ICTC is:

a) Desk for the counselor.

b) 10–15 chairs for one-on-one and group counselling sessions as well as for the waiting area.

c) Lockable filing cabinet for keeping records.

d) Computer with printer and UPS.

e) Computer table, preferably with a chair.

f) Waste basket.

g) TV and DVD player in a lockable stand for provision of information on HIVorAIDS, non-communicable disease, etc. to clients.

h) Posters and information materials on the walls.

i) Communication aids such as flip charts.

j) Condom use demonstration models.

k) Leafletsorpamphlets as take-home material for clients.

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

Appendix 3

Human Resource Requirements

1.1Manager (Medical officer)-1: The administrative head of the facility where the ICTC is located must identify and nominate a medical officer as manager in-charge of the ICTC.

1.2Counsellor-1: The counsellor should be a graduate in PsychologyorSocialWorkorSociologyorAnthropologyor Human Development or hold a diploma in Nursing with a minimum of 3–5 years of experience in the field of HIVorAIDS. In the case of those recruited from the community of people infected with or affected by HIVorAIDS, graduates from any field or those with a diploma in Nursing may be considered if they have a minimum of one year of experience in the field of HIVorAIDS.

1.3 Lab Technican-1: Should hold a Diploma in Medical Laboratory Technology(DMLT) from an institution which is approved by the state government. The services of existing LTs who do not hold a DMLT may be continued if they have done a Certificate Course in Medical Laboratory Technology and have more than 5 years’ experience of working in the ICTC.

1.4An outreach worker would be necessary in high-prevalence districts:

Outreach workers should be educated at least till the eighth standard with reasonable writing and speaking skills, and should be from the community of people who are infected with or affected by HIVorAIDS. A person affected with HIVorAIDS may be the spouse or the sonordaughter of a person infected with HIVorAIDS. It is desirable that outreach workers should have passed the tenth standard and are women. Outreach workers are recommended only in ICTCs which are located in high-prevalence settings such as in A and B category districts.

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

Appendix 4

Equipments or Instruments or Consumables

1. The equipment required for testing in an ICTC are:

a) Refrigerator

b) Centrifuge

c) Needle destroyer

d) Micropipette

e) Colour-coded waste disposal bins.

2. The consumables required for collection and testing of blood in an ICTC are:

a) Sterile needles and syringes

b) Disposable gloves

c) Vials and tubes for collection and storage of blood

d) Cotton swabs

e) Cleaning material such as spiritorantiseptic lotion

f) Bleachorhypochlorite solution

g) Microtips for use in micropipettes.

h) Prophylactic nevirapine tablets and syrup (for HIV-positive pregnant women and their infants).

i) Contraceptives.

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

Appendix 5 Records or Registers to be maintained:

a) PID Register for General Clients and Pregnant Women

b) ICTC Register for General Clients (Non-ANC Cases)

c) ICTC Register for ANC Clients

d) ICTC Post-natal Follow-up Register

e) ICTC HIV–TB Collaborative Activities Register

f) Laboratory register

g) Stock Register

h) Monthly reports

i) Monthly ICTC report on the number of clients counselled, tested, HIV status, NVP administration, and gender and age-wise distribution

j) Monthly HIV–TB report on HIV–TB collaborative activities

k) Details of referrals to and from various facilities

l) Stock of drugs, equipment and consumables

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

Glossary

Volunatry

Client

“Self-referred clients”

“Provider- referred clients”

Seeking knowledge of the HIV status is voluntary. The decision to pursue testing for HIV must be made by the client who seeks counselling and testing services.

A person seeking health-care services, including in an ICTC, is a client and not a patient. Patients are considered passive recipients of treatmentorcareorhospitalization, whereas clients are “consumers” who make a choice whether or not to avail of a certain service.

“Self-referred clients” or direct walk-in clients are clients who present themselves at the ICTC of their own volition and free will. The motivation to visit and avail of ICTC services could be based on individual risk behaviour or information and advice received, for example, from a newspaper advertisement, a friend, sexual partner or NGO.

“Provider-referred clients” are clients who are referred by health- care providers to the ICTC for HIV counselling and testing based on clinical symptoms suggestive of an HIV infection. An HIV test as part of the medical investigation can be beneficial for their ongoing medical care and treatment. The decision to undergo an HIV test is voluntary but should be encouraged in view of the clinical benefits. Not undergoing an HIV test should not lead to withholding required medical investigations or operations.

Confidential Information gathered during counselling must not be shared with others. The HIV test result must be reported only to the client

unless the client states the desire to share the test result with a family member, partner or close friend. Confidentiality is defined as the state of being “private”. Maintaining the client’s privacy by restricting access to personal and confidential information, especially HIV test results, demonstrates sensitivity towards and respect for the basic rights of the client.

Informed The client agrees to HIV testing through giving hisorher informed

consent for HIV testing

consent. Informed consent is a deliberate and autonomous permission given by a client to a health-care provider to proceed with the proposed HIV test procedure. This permission is based on an adequate understanding of the advantages, risks, potential consequences and implications of an HIV test result,

Clinical Establishments Act Standards for Integrated Counselling and Testing Centre CEA orICTC

which could be both positive and negative. This permission is entirely the choice of the client and can never be implied or presumed.

Informed

The law gives paramount importance to the best interests of the child. In the context of HIVorAIDS, the best interests of the child are served by promoting access to information and services including counselling and testing services. Whenever possible, minors areencouraged to involve their parentsorguardians in supervising their health care. However, unwillingness to inform parentsorguardians should not interfere with the minor’s access to information and services. Access to ICTC services should be available to children and young people under the age of 18

years based on an assessment of their evolving capacities and their ability to comprehend the nature and implications of HIVorAIDS and an HIV test result. It is the role of the trained counsellor to assess these abilities.

However, the informed consent of parentsorguardians is required prior to testing minors for HIV.

consent for HIV

testing of

minors

Clinical Establishments Act Standards for Physiotherapy Centre

Clinical Establishments Act Standard for

Physiotherapy Centre

Standard No. CEAorPhysiotherapy Centre

Clinical Establishments Act Standards for Physiotherapy Centre

Table of Contents

Particulars

Page No.

Definition

Scope

Infrastructure

Furniture & Fixtures

EquipmentorInstruments

Human Resource

Support Service

Legalorstatutory Requirements

Record Maintenance and Reporting

Process

Appendix 1

Appendix 2

Appendix 3

Appendix 4

Clinical Establishments Act Standards for Physiotherapy Centre

50 Definition

A physiotherapy centre is an allied Healthcareestablishment providing, physicaltherapy services by a physiotherapist to patients with a recent prescription or referral from a licensed medical doctor (physicianorsurgeon). Depending on the disease condition a review and re-prescription by atreating medical doctor is required for continuing physiotherapy services.

51 Scope (as applicable)

These set of common minimum standards framed shall be applicable to standalone physiotherapy centre with one or more physiotherapists

2.1 And physiotherapy sections attached to hospitals or polyclinic.

2.2 Various therapies under the scope is as follows:

2.2.1Electrotherapy (Adult or Paediatrics)

a) Hydrocollator (Hot Packs).

b) Paraffin Wax Bath InfraredorUltra violet radiation lamps. (Cold) – Cryotherapy.

c) Shortwave diathermy

d) Ultra sound Therapy (1 & 3 MHz).

e) Electrical energy- TENS (Trans cutaneous Nerve Stimulator).

f) Low and Medium frequency currents: IFT(Interferrential Therapy)or

g) Electrical muscle stimulator.

2.2.2 Exercise therapy

a) Shoulder exercise unit

b) Wrist and Hand exercise units

Clinical Establishments Act Standards for Physiotherapy Centre

c) Abduction ladder

d) Over head Pulley systemor Multiple Pulley exercise unit

e) Weight cuffs(Optional)

f) Dumbbell exercise set, Mat exercise (floor) mat

g) Parallel Bars and Wall bars

h) Examination couches (number according to the patient load)

i) Quadriceps table, MobilizationorStabilizing belts, Patient evaluation kit (including Goniometer, Percussion Hammer, Measuring tape etc.), Walking aids(sticks, crutches, frames and wheel chairs etc.)

2.2.3Mechano Therapy

a) Cervical and Lumber Traction systems(Intermittent and Constant) with

traction table

2.2.4 Hydrotherapy

2.2.5 Manual therapy

a) To deliver primary service in health education and health promotion.

b) To deliver health care services of physiotherapy and rehabilitative nature.

52 Infrastructure Requirements

3.2 The minimum space requirement for carrying out the basic functions of the facility shall be as per Appendix 1.

Clinical Establishments Act Standards for Physiotherapy Centre

3.3 The area shall be well illuminated, ventilated and clean with adequate water supply.

3.4 The total area requirement can be broadly classified into two categories viz. Common Area and Treatment area. The common area shall include facilities such as reception, waiting, toilet, consultation, etc. The treatment area shall include space requirements for main equipment and for ancillary services.

3.5 The facility shall be adequately provided with working space to allow orderly and logical placement of equipment, material and movement of personnel so as to maintain safe operations.

3.6 The space requirement in treatment area shall be as per as per the scope of service and workload. The ancillary area like facility for storage (cabinet etc), facility for backup equipment like UPSorgenerator etc. shall also be available, please refer to Appendix 1.

3.7 Common area can be shared between the different divisionsorsections of the centreorHCO. Within the centre various work sections can also share the resources and space however not compromising the quality of work.

3.8 The physiotherapy centre shall have a prominent boardorsignage displaying the name of the centre in local language at the gate or on the building.

3.9 The following other signage shall be well displayed in the language understood by the local public in the area:

a) Name of the physiotherapist with registration number.

b) Fee structure of the physiotherapistor physical therapy services.

c) Timings (For ex – from 8am -2pm)

d) Services provided within the facility

4.1 Furniture and fixtures shall be available in accordance with the activities and workload of the physiotherapy centre.

Furniture & Fixtures

Clinical Establishments Act Standards for Physiotherapy Centre

4.2 The furniture and fixtures shall be functional all the time. For indicative list of items refers to Appendix 2. (This list is indicative and not exhaustive).

54 EquipmentorInstruments

5.1 The physiotherapy centre shall have essential equipments as per Appendix 4.

5.2 Other physiotherapy equipments as per the scope of service and work load requirement shall be available.

5.3 Adequate space for storage of equipments

5.4 All equipment shall be in good working condition at all times. Periodic inspection, cleaning, maintenance of equipments should be done.

55 Human Resource

6.1 Physiotherapist as per the scope of the physiotherapy centre shall be registered with State physiotherapy & Occupational Therapy Council, wherever applicable.

6.2 The services provided by the physiotherapy professionals shall be in consonance with their qualifications, training and registration.

6.3 Personnel record containing personal and professional information shall be maintained for each staff.

6.4 Periodic skill enhancementorup gradation orrefresher trainings shall be provided for all categories of the staff relevant to their job profile.For Human resource requirement refer to Appendix 3.

56 Support Service

7.1 Support services like registration, billing, waste management, etc., can be shared with the hospital.

7.2 Support Staff: In a physiotherapy centre minimum one support staff shall be available to meet the care treatment and service needs of the patient. However number may depend upon the workload and scope of the service being provided by the clinical establishment.

57 Legalorstatutory Requirements

Clinical Establishments Act Standards for Physiotherapy Centre

8.1 Every application must be accompanied with the documents confirming compliance with local regulations and law.

58 Record Maintenance and Reporting

9.1 Copies of all records and statistics shall be kept with the clinical establishment concerned for at least 3 or 5 years or in accordance with the CEA act.

9.2 All clinical establishments shall be responsible for submission of information and statistics in time of emergency or disaster or epidemic situationor as required from time to time by National Council CEA 2010.

59 Process

10.1 Registration: Every patient visiting the physiotherapy centre shall be registered.

10.2 Assessment and plan of care The physiotherapist cardorslip of every registered patient must bear the minimum following legibly at every visit:Working diagnosis as provided by the treating medical doctor who has referred the patient, Relevant history and examination findings, Plan of care listing the exercises and physical modalities, Signature and date of the physical therapist, A review and re-prescription from the treating medical doctor after three weeks for continuing plan of care.

10.3 Infection Control:

a) The physiotherapy centre shall take all precautions to control infections

like practicing hand hygiene etc.

b) Availability of clean water for hand washing orliberal use of sanitizer shall be maintained throughout the working hours of the physiotherapy centre.

c) Sanitation and hygiene of the toilets if available shall be maintained.

d) Mopping of all patient care areas with disinfectant shall be done at least once a day.

10.4 Safety Considerations

Clinical Establishments Act Standards for Physiotherapy Centre

a) The establishment shall make effort shall to take care of patient safety aspects like patient fall, etc.

b) The establishment shall make effort to keep the centre pest and termite free.

10.5Biomedical waste Management

a) Biomedical waste shall be managed in accordance with the BMW

management and handling Rules, 1998.

10.6.FirstAid

a) Provision shall be made for providing First Aid.

b) Contact details of ambulance hospital etc shall be available.

c) Staff shall be trained on BLS.

Clinical Establishments Act Standards for Physiotherapy Centre

Appendix – 1

Minimum infrastructure requirements shall be as follows:

S.No

Minimum Area

Reception, Waiting & Consultation

Reception, waiting, consultation room etc. shall be adequate as per the requirement and workload of the physiotherapy center

Ancillary area or space

Ancillary areaorspace for storage of records, reagents, consumables, stationary etc including eating area for staff shall be available in accordance with the workload

Electrotherapy (Adult or Paediatrics)

Minimum one chamber of 10 ft.X7 ft for Diathermy unit and another chamber of same size for other electrotherapy modalities with examination couches, linen and electric fitting of required load, as per the specifications of the modalities. Separate space for Wax Bath and Hydrocollator as per the patient load and equipment specifications

Exercise Therapy

Minimum one consultation room (15 ftX10 ft at least), Treatment roomsorcabins (at least three of 10ftX10ft each) and space for the Parallel bars, Gait training and Floorormat exercises. The centre should have essential facilities like wash basins, wash rooms etc.

Mechano Therapy

Minimum one chamber of 10 ft.X7 ft to accommodate Cervical and Lumber Traction systems (Intermittent and Constant) with traction table and other material so as to provide adequate working space to carry out safe procedure.

Manual therapy

Manual therapy couch or the Examination couch. can be accommodated in the Exercise therapy space.

Hydrotherapy

Optional. If there, should be placed in the separate chamber of the size as per the equipment specifications. For example if Hubbard’s equipment is used, it requires a chamber of not less than 15ftX15ft along with the facility of changing room and wash room.

Clinical Establishments Act Standards for Physiotherapy Centre

Appendix –2 Furniture and Fixtures

S.N.

ARTICLES

Table

Chairs

Examination Tableorcouch

Screens

Foot Step

Stools

Storage Cabinet for records etc.

BMW storage area

Clinical Establishments Act Standards for Physiotherapy Centre

Appendix- 3

Indicative list of minimum equipmentorinstrument required is as follows:

I. Essential Equipment:

S. No.

Name of the equipment

Minimum Specifications

No. of equipment

Stethoscope

Thermometer

Digital

Torch (flash lights)

Sphygmomanometer (B.P. Apparatus)

Digital

Weighing machine (Optional)

Adult

II. Emergency Equipment:

III. PHYSIOTHERAPY EQUIPMENT

The physiotherapy equipment relevant to the scope and workload shall be available as follows:

S. No.

Name of the Equipment

Minimum Specifications

No. of Equipment

Fire Extinguisher

–

PHYSIOTHERAPY EQUIPMENT

Electrotherapy Equipment

Short Wave Diathermy

Ultrasonic Therapy

Interferential Therapy

Hot Pack Unit

Paraffin Wax Bath

TENS

LASER (Optional)

Clinical Establishments Act Standards for Physiotherapy Centre

9 10

Exercise Therapy Equipment

19 20

29 30

Mechano Therapy

Manual therapy

Hydrotherapy

Muscle Stimulator

Cold Packs

C.P.M.

Shoulder Wheel

Over Head Pulley

Wall Ladder

Supinator Pronator Exerciser

Heel Exerciser

Ankle Exerciser

Parallel Bars(optional)

Tilt Table (optional)

Walker or Crutches or Canes

Stationary Bicycle

Treadmill (Optional)

Vibrator for Chest Physiotherapy(Optional)

Swiss Ball (Optional)

Dumbbells or Weight Cuffs (Optional)

Gripper or Gel Balls (Optional)

Thera Bands or Thera Tubes (Optional)

Spiro meter (Optional)

Peak flow meter(Optional)

Hydrotherapy (Optional)

Traction Unit (Cervicalor Lumbar)

Manual Therapy couchorExamination couch (Optional)

Hydrotherapy pool or Hubberd tank (Optional)

Clinical Establishments Act Standards for Physiotherapy Centre

Appendix- 4

Minimum human resource requirement shall be as follows:

S. no.

Category

Minimum Qualifications

(from recognized university)

Registration with the concerned council

(if applicable)

Remarks

Physiotherapist-1

BPT from recognized universityorDPT awarded till 1991 from recognized University

State Physiotherapy& Occupational Therapy Council

Where council registration is not applicable, registration shall be done with Indian association of physiotherapy

CONTENTS

Minimum Standards of specific speciality / Super speciality Clinical

Departments / Establishments

S.No. Title

Page No.

1 -5 6-8 9-10 11-12 13-15 16-17 18-19 20-21 22-25 26-27 28-29 30 31-32 33-34 35-37 38-39 40-41 42-43 44-45 46-47 48-49 50-51 52-53

25 Gynaecology and Obstetrics Services in Hospital 54-55

26 Gynaecology and Obstetrics Clinic 56-57

27 IVF Clinic ( ICMR Norm)

28 Imaging Centers- X Ray Clinic/ Cath lab/ DSA/ OPG and Dental / DEXA Scan 60-63

29 Imaging Centres-Sonography(Color Doppler)Clinic 64-66

1 Anaesthesiology/Intensive Care/Emergency Dept

2 Burn Care Facility in Hospital

3 Plastic Surgery in Hospital

4 Clinic with Plastic Surgeon

5 Cardiology Services in Hospital

6 Clinic with Cardiology Service

8 CTVS in Hospital

9 Clinic with CTVS Service

10 Dental set up-stand alone/Hospital set up

11 Dermatology Services in Hospital

12 Dermatology clinic

13 STD clinic

14 Endocrinology Services in Hospital

15 Endocrinology clinic

16 Otorhinolaryngology Services in Hospital

17 Clinic with Otorhinolaryngology Services

18 Deaf and Dumb Clinic

19 Gastroenterology Services in Hospital

20 Clinic with Gastroenterology Services

21 Gastrointestinal Surgery Services in Hospital

22 Clinic with Gastrointestinal Surgery Services

23 General Surgery in Hospital

24 General Surgery Clinic

30 Imaging Centres-CT Scan Centres/PET CT Scan

31 Imaging Centers- MRI

32 Medical Diagnostic Laboratories

33 Medicine and Geriatric Services in Hospital

34 Medicine and Geriatric Clinic

35 Nephrology Services in Hospital

36 Nephrology Clinic

37 Dialysis Centre

38 Neurology Services in Hospital

39 Neurology Clinic

40 Neurosurgery Services in Hospital

41 Clinic with neurosurgery services

42 Medical Oncology / Clinical Haematology

43 Medical oncology / Clinical Hematology Clinic / Polyclinic

44 Gynaecological Oncology

58-59

67-70 71-73 74-80 81-82 83-84 85-87 88-89 90-91 92-93 94-95 96-97 98-99

100-101 102-103 104-105

Gynaecological Oncology Clinic/ Polyclinic

Surgical Oncology

Surgical Oncology Clinic / Polyclinic

Ophthalmology Services in Hospital

Clinic with Ophthalmology Services

Optometrist Services

Orthopaedic Services in Hospital

Clinic with Orthopaedic Services

Paediatric Services in Hospital

Paediatric Clinic

Neonatology

Neonatology Clinic

Psychiatric Services in Hospital

Psychiatry Clinic

De addiction Centre

Paediatric Surgery

Paediatric Surgery Clinic/ Polyclinic

Palliative Care

PMR Clinic

Pulmonology Services in Hospital

Pulmonology Clinic

Radiotherapy Services

Rheumatology Services in Hospital

Rheumatology Clinic / Polyclinic

Urology

Clinic with urology services

45 106-107 46 108-109 47 110-111 48 112-114 49 115-116 50 117-118 51 119-121 52 122-123 53 124-126 54 127-128 55 129-131 56 132-133 57 134-136 58 137-139 59 140-141 60 142-143 61 144-145 62 146-147 63 148-149 64 150-151 65 152-153 66 154-156 67 157-158 68 159-160 69 161-162 70 163-164

Template for Minimum standards for Hospital

BASIC (General purpose)

Advance (Non Teaching)

Remarks

1 Definition

2 Scope

Providing Anaesthesia services for Surgical Specialities eg. (General Hospital with Single Specialities/Multiple Specialities example CHC SDH,DH,Civil Hospital,Private Hospital,Nursing Home)etc

ProvidingAnaesthesiaservicesforSurgical Specialities and Superspecialities example Civil Hospital, Regional Hospital,Nursing Home,Private Hospital etc.

I Services Provided 1.General purpose 2.Single Speciality 3.Multispeciality 4.Superspeciality

Yes Yes Yes NA

Yes Yes Yes

3 Human resources 1.1 Doctors

Duty Doctors

1 MBBS Doctor/6 ICU Beds /for round the clock medical cover **

* D ** M

1.2 Nurses Nursing head General nurses

1 Head Nurse/OT 1 Nurse/OT

1 Head Nurse/OT 2 Nurses/OT

As per Nursing Council norm M

ANAESTHESIOLOGY/INTENSIVE CARE/EMERGENCY DEPT

1 Qualified Anaesthetist/OT/per operation

M-MandatoryOneAnaesthetist per OT per 8hour shift, subject to a maximum of 42 hours per week per anaesthetist. Full time employment not mandatory

MD/DNB/Diploma Anaesthesia

1 consultant Intensivist/6 ICU Beds **

M-Mandatory

D-Desirable

*D-Desirable(MBBSDoctorwith training in emergency Medicine or Sr. Resident)

** M- Mandatory

Trained Nurses for ICU/OT/HDU

1.3 Pharmacist

1 Nurse/1 Ventilator patient; 1 Nurse/1NICU Beds;1 Nurse/2 ICU beds

part of hospital

1.4 Para Medical staff Lab Tech

Xray Technician

OT Technician

NA for Anaesthesia NA for Anaesthesia 1/OT;I Supervisor/2 NA for Anaesthesia NA for Anaesthesia NA for Anaesthesia NA for Anaesthesia NA for Anaesthesia

NA for Anaesthesia

NA for Anaesthesia 1/OT;I Supervisor/2 OT NA for Anaesthesia

NA for Anaesthesia

M- Mandatory

ECG Technician

Dietitician

Physiotherapist

Psychologist

Medicosocial worker

1.5 Support Staff

a.Receptionist & Billing

Yes Yes Yes

part of hospital part of hospital part of hospital

b.MRD Office

c.Securityclosed circuit surveillance and sanitation d.Transport facility including driver

Yes

Own or outsource

e.Data entry operators

Yes Yes Yes

part of hospital M

part of hospital

f.House keeping

1.6 Rapid Response Team

1.7 others

Policy Manpower/ posting/ rotation/ of medical and ALLIED HEALTH PROFESSIONAL STANDARD PERTAINING TO PERSONAL RECORD KEEPING AND TRAINING

Yes Yes

PAYMENT/ROSTER OF STAFF

Yes Yes

part of hospital

part of hospital policy

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff in lab,bld bank,TLD badges

4 Equipment

Therapeutic

D type Oxygen cylinders / O2 tank and / or concentrator .Liquid oxygen set up with emergency cylider supply, Nitrous oxide supplythroughcylidersbank,MedicalAir supplyandvacuumsetup.Pipedmedical gases.Anesthesia EquipmentAnesthetic /machine with hypoxic guard and inbuilt oxygen analyser.Anesthesia monitor with

Surgical Diagnostic

Magill`s forceps

Intubating stylet and bougie

Oral and nasal airways (all sizes)Anesthesia Equipment Laryngoscope with blades of all sizes Endotracheal tubes of all sizes

Magill`s forceps

Intubating stylet and bougie

Oral and nasal airways (all sizes) Laryngeal mask airway (classic/proseal , all sizes)

Anatomical face masks all sizes Breathing circuits (Adult and pediatric) Laryngeal mask airway (classic/proseal , all percutaneous tracheostomy set, cricothyrotomy set,

ultrasound for nerve blocks and central venous cannulation

OT- Anaesthesia Work Station (Anaesthesia

Delivery System) attached to cylinders and

/or piped gases, Defibrillator for one OT complexoftwintheatredependinguponthe typeofcases,canbereducedforASAgrade

1or2cases, Laryngoscopeswithbladesof

all sizes. Endotracheal tubes of all sizes,

Anatomical face masks of all sizes, Guedal’s Airwayofallsizes,LaryngealMaskAirwayof facility for monitoring SpO2, Pulse rate, all sizes, Intubating Stylet and Bougie.

Central venous canulation set, Spinal and epidural set

NIBP, ECG and EtCO2.Anesthesia monitor with facility for monitoring SpO2, Pulse rate, NIBP, ECG, temperature and EtCO2 . Flexible FIbreoptic BronchoscopeSelf inflating resuscitator bag and mask – adult and neonatal sizeAnesthesia Equipment Laryngoscope with blades of all sizes Endotracheal tubes of all sizes

Emergency

Equipment:DifficultAirwayCart,Oxygen Equipment:DifficultAirwayCart,Oxygen

Difficultairwaycartwould include the following items: Resuscitation equipment including Laryngoscope with cells and different blades, endotracheal tubes of all sizes (2.5 TO 8.5mm ID),suctionequipment(electrical and manual, central optional ), lignocaine spray, oropharyngeal andnasopharyngealairways, anatomicalfacemasks(allsizes) self inflating resuscitator bag- Adult & Paediatric (neonatal if indicated)laryngealmaskairway.

Sterlizing

Yes Yes

M-Mandatory

cylinders with flow

meter/tubing/catheter/face mask/nasal

prongs, Suction apparatus (electrical and

manual, central optional, Portable

defibrilator with accessoriesa, Equipment

for dressing/bandage/suturing, Basic

Diagnostic equipment: BP apparatus,

stethoscope, weighing machine,

thermometer,ECGmachine,Pulseoximeter,

nebulizer andaccessories.

Emergency Drugs: Injections: Diazepam,

Furosemide, Ondasetron, Ranitidine, Nor- Furosemide, Ondasetron, Ranitidine, Nor-

adrenaline, Phenytoin, Diclofenac,

Deriphylline, Chlorpheniramine maleate,

Hydrocortisone, Atropine, Adrenaline, KCl,

Sterile water, Sodium bicarbonate,

Dopamine, Naloxone (400mcg), Lignocaine (preservativefree(50m)l,Suxamethoium,

Atracurium/ Vecuronium/ Rocroronium,

Neostigmine, Calcium Chloride and

gluconate, Morphine/ Pethidine,

Metoclopramide, Tramadol, Salbutamol

Nebulizer, Steroid (Budesonide) Nebulizer,

Lignocaine Jelly, Activated Charcoal: IV

Fluids: Ringer lactate/acetate, Normal saline,

(500, 250, 100 ml), 5% dextrose, 10%

dextrose,10%Dextrose,PaediatricInfusion 100ml),5%dextrose,10%dextrose,10% solution, Dextrose, Paediatric Infusion slolution,

cylinders with flow meter/tubing/catheter/face mask/nasal prongs,Suctionapparatus(electricaland manual, central optional, Portable defibrilator with accessoriesa, Equipment for dressing/bandage/suturing, Basic Diagnostic equipment: BP apparatus, stethoscope, weighing machine, thermometer,ECGmachine,Pulse oximeter, nebulizer and accessories Emergency Drugs: Injections: Diazepam,

adrenaline, Phenytoin, Diclofenac, Deriphylline,Chlorpheniraminemaleate, Hydrocortisone, Atropine, Adrenaline, KCl, Sterile water, Sodium bicarbonate, Dopamine, Naloxone (400mcg), Lignocaine(preservativefree(50m)l, Suxamethoium, Atracurium/ Vecuronium/Rocroronium, Neostigmine, Calcium Chloride and gluconate, Morphine/ Pethidine, Metoclopramide, Tramadol, Salbutamol Nebulizer, Steroid (Budesonide) Nebulizer, Lignocaine Jelly, Activated Charcoal: IV Fluids: Ringer lactate/acetate,Normalsaline,(500,250,

Drugs,Medical devices and consumables

Anaesthesia Inductions Agents: Thiopentone/ Propofol/ Ketamine / Etomidate (optional), Inhalational Agents: Sevoflurane/Isoflurane/Halothane:Muscle Relaxants: Suxamethonium, Vecuronium/ Pancuronium/ Atracurium/ Rocuronium, Opioids:Pentazocine/Tramadol/Morphine/ Pethidine, Fentanyl/ Buprenorphine,Others: Neostigmine, Atropine, Glycopyrolate, Midazolam, Diazepam (Inj & Tab), Alpralozolam (tab), Diclofenac (Injection, and suppositories), Paracetamol (Inj and suppositries), Adrenaline, Magnesium sulphate and other emergency drugs to be finalized in themeeting

Anaesthesia Inductions Agents: Thiopentone/ Propofol/ Ketamine / Etomidate (optional), Inhalational Agents: Sevoflurane/ Isoflurane/ Halothane: Muscle Relaxants: Suxamethonium, Vecuronium/ Pancuronium/ Atracurium/ Rocuronium,Opioids:Pentazocine/ Tramadol/ Morphine/ Pethidine, Fentanyl/ Buprenorphine, Others: Neostigmine, Atropine, Glycopyrolate, Midazolam, Diazepam (Inj & Tab), Alpralozolam (tab), Diclofenac (Injection, and suppositories), Paracetamol (Inj and suppositries), Adrenaline, Magnesium sulphate and other emergency drugs to be finalized in themeeting

List of disposables

Endotracheal tubes, Spinal sets, Epidural sets, Central venous canulation sets

Endotracheal tubes, Spinal sets, Epidural sets, Central venous canulation

Annual Maintenance records

Yes

of equip

5 Support Service

Reception &Billing Laboratory

Imaging

Pharmacy sterlization/CSSD Laudry/Kitchen Medical Gas/Manifold

Yes Yes Yes Yes Yes Yes

Yes

part of hospital part of hospital part of hospital part of hospital M

Blood storage unit/blood Bank Amb service

With adequate storage of all blood groups and blood products depending upon the requirement of Hospital set up

part of hospital

part of hospital Own or Outsource

Liquid oxygen set up with emergency cylider

Liquid oxygen set up with emergency cylider supply, Nitrous oxide supply

supply, Nitrous oxide supply through

cyliders bank, Medical Air supply and vacuum set up

through cyliders bank, Medical Air supply and vacuum set up

Yes

sets,arterial cannula, laryngeal mask airways

Yes

part of hospital part of hospital

1 Scope

OPD Services, Short stay services eg, treating dehydration, nebulization, immunization (e.g CHC, SDH, District Hospital, Civil Hospital, Private Hospital, Nursing Home etc)

Provide advance paediatrics care Eg. CivilHospital,regionalHospital,Nursing Home,Private Hospitaletc

Minimum standards for Hospital

BASIC (General purpose)

ADVANCE (Non Teaching)

Remarks

Services Provided

1.1General purpose 1.2Single Speciality 1.3Multispeciality 1.4Superspeciality

Yes Yes Yes NA

Yes Yes Yes

2 Human resources 2.1 Doctors

Medpersonincharge

MDPAEDIATRICS/DNB/DCH/MDMedicine

SeniorConsultant-1

M-Mandatory M-Mandatory

Full time consultant Part time consultant visiting consultant Duty Doctors

MBBS Doctor to provide round the clock Medical cover

Junior consultant-1 or

or 1

MBBS Doctor to provide the clock Medical cover

2.2 Nurses

Nursing head

General nurses TrainedNursesforICU/OT/HDU Yes

Nurse-1/4 beds Yes*

2.3 Pharmacist

own / outsource

PAEDIATRIC SERVICES IN HOSPITAL

As per norms of Nursing Council

2.4 Para Medical staff a. Lab Tech

b. Xray Technician

c. OT Technician

Yes Yes

M- if own lab

M- if own

part of Hospital

D Part of Hospital *Desirable **Mandatory part of Hospital (if required) *Desirable

d. ECG Technician e. Dietician

f. Physiotherapist

Yes Yes* Yes*

Yes Yes** Yes*

g. Psychologist

h. Medicosocial worker

Yes* Yes*

M IF PSYCHIATRIST *Desirable

3 Equipment

a.Therapeutic

For neonatal service-phototherapy unit-1 radiant warmer-2 suction-1

Yes

For neonatal service-phototherapy unit- 1 radiant warmer-2 suction-1

Yes

b.Surgical c.Emergency

if applicable

Refer to documents on Hospital

Refer to Documents on Hospital

d.Sterlizing

e. Drugs,Medical devices and consumables

f. List of disposables

g. Annual Maintenance records of equip

Yes Yes

4 Support Services

a.Laboratory b.Imaging

Yes Yes

M; own/ Outsource/ Tie up M; own/ Outsource/ Tie up

Yes Yes

*Desirable

c.Pharmacy Yes* Yes

M-IN ADVANCED *Desirable

d.sterlization/CSSD Yes Yes e.Medical Gas/Manifold Yes Yes f.Bloodstorageunit/bloodBank Yes Yes

M-own/ outsourced/ TIE UP

g.Amb service Yes Yes h.other requirement

M-own/ outsourced/ TIE UP

M-Mandatory D- Desirable

D – separate enclosure for male and female PATIENTS AGED 12 yrs AND ABOVE

Template for Minimum standards for Clinics/ Polyclinics

Minimum Standards

Remarks

1 Definition

2 Scope

General/Specialist

OPD consultation, Immunization (optional),

Services Provided

3 Physical Infrastructure a.Space requirement

i) Reception

ii) consultation/waiting area

Yes Yes

4 Human Services

a.Doctors

b.Tech staff

c.Non Tech staff

d.Duty and salary roster

MD/DNB/DCH-PAEDIATRICS/MBBS NURSE-1

Attendant-1

Yes

Either Nurse/Attendant D

e.OTHER REQUIREMENT LIKE PERIODIC HEALTH

CHECK UPS

5 Equipment

a.Stethoscope b.Thermometer c.BP Apparatus d.Glucometer

Yes Yes Yes Yes

M(paediatric)

Yes (Non Mercury) Yes (Non Mercury) D

e. Weighing machine

paediatric weighing scale, pulse oximeter*

M except pulse oximeter*

M-if Immunization

As provided in clinic/polyclinic document M

f.Emergency kit and medicine g.Drugs,Medical devices and consumables

Refrigerator(if immunization) Yes

Yes

PAEDIATRIC CLINIC

h.List of disposables

Yes Yes

D applicable for major equipment

i.Annual Maintenance records of equip

6 support services

a.sterlization/CSSD b.security

c.BMW management d.Laundry

Yes Yes Yes Yes

M if immunization

Own / Outsourced(if applicable)

7 Standard on basic processes

a.Receiving patients,privacy for patients while examining especially females

b.Infection control practices

soap and water

facilities for hand washing and disinfection Disinfection of work Area

Use of disposable services

small autoclave

c. Policy on outsourced services

Yes

M- Mandatory

M M M M M M D

D – Desirable

TemplateforMinimum BASIC ( Burn care facility for general

ADVANCECARE(Burnunit)

Remarks

standards for Hospital

/general surgical care )

1 Scope

PATIENTS WITH UPTO 25% TBSA (total body surfacearea)inadultand15%inchildren burns with no comorbid condition

All burns patients (Minimum 2 beds with ICUfacility)

Services Provided

1.General purpose 2.Single Speciality 3.Multispeciality 4.Superspeciality

Yes Yes Yes

2 Human resources 1.1 Doctors

Med person incharge Full time consultant

for Anaesthetist services refer to Doc on Anaesthetist

Part time consultant visiting consultant Duty Doctors

Need based depending on case load

1.2 Nurses Nursing head General nurses

Yes Part of Hospital

Trained Nurses for ICU/OT/HDU

1.3 Pharmacist

1.4 Para Medical staff Lab Tech

Staff Nurses-2 ,round the clock on shared Yes Part of Hospital basis

Yes Yes Part of Hospital

Xray Technician OT Technician

Yes Yes M- Mandatory; if own lab

Yes Yes M- if own

Yes Yes M- in Major OT( In Minor OT trained Technician)

MINIMUM STANDARDS FOR BURN CARE FACILITY IN HOSPITAL

Surgeon-1 (MS General Surgeon)

MCh /DNB Plastic Surgery-1

M (Full Time)

MBBS doctor to provide round the clock medical cover

MBBS doctor to provide round the M – Mandatory clock medical cover

Need based depending on case load

1MS Surgery full time, if no. of beds exceed 6, and part time if no. of beds less than 6

Yes Yes Part of hospital

ECG Technician Yes Dietician Yes Physiotherapist Yes Psychologist

Yes Yes Yes Yes Yes

D – Desirable; part of hospital D – Desirable; part of hospital D – Desirable; part of hospital D – Desirable; part of hospital *M – Mandatory; part of hospital

Medicosocial worker

3 Equipment

Therapeutic

Vital parameter monitor2, skin graft mesher1,Humby’s knife- 2,Portable light-1

Humby’s knife 2 Mandatory and 4 – Desirable

Emergency Yes

Yes

Refer to documents on Hospital M-Mandatory

Sterlizing

Yes

Drugs,Medical devices and consumables

I/VFluids,Antibiotics,Sedatives,Anal

These are minimum requirements

List of disposables

Yes Yes

Antiseptic cream, Plasma expanders

Yes

M-Mandatory M

Annual Maintenance

Yes

records of equip

4 Support Service

sterlization/CSSD Medical Gas/Manifold

Yes

Yes Yes* Yes

M-Mandatory *M-Mandatory M-own/outsourced/Tie up

Blood storage unit/blood Bank

Amb service

Yes Yes

Yes

M-own/outsourced/Tie up

I/VFluids,Antibiotics,Sedatives,Analgesics,

Antiseptic cream, Plasma expanders gesics,

Ulrasonic therapy machine-1,

Overhead pulley-1, Shoulder wheels

1,Horizontal bar-1,static cycle-

1,Quadriceps table-1,Breathing

exercise equipment-1, Handgripper-

1,Electric musclestimulator- 1,Paraffin box-1

1 Definition

Surgical Speciality which deals with reconstruction of missing parts, replacement of tissue, modification and changing of existing part and changing the appearance of person to improve aesthetic appearance

2 Scope

Reconstructive Surgery,Facial skeletal surgery, Aesthetic surgery, Minor surgical procedures

Minimum standards for Hospital

Minimum Standards

Remarks

Services Provided

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

yes Yes Yes

3 Human resources 3.1 Doctors

Med person incharge

MCh / DNB Plastic Surgery-1

M-Mandatory; for Anaesthetist services refer to Doc on Anaesthetist

Duty Doctors

3.2 Nurses

Nursing head

General nurses

Trained Nurses for ICU/OT/HDU 3.3 Pharmacist

MBBS doctor for round the clock medical cover from Hospital pool

M-Mandatory; part of Hospital

3.4 Para Medical staff a. Lab Tech

b. X-ray Technician

c. OT Technician

Yes Yes Yes

M- Mandatory;if own lab M- if own

d. ECG Technician e. Dietitician

Yes Yes

M- in Major OT ( In Minor OT trained Technician)

D-Desirable; part of hospital

D; part of hospital

PLASTIC SURGERY IN HOSPITAL

MS (General Surgeon) with minimum 3 yrs training in Plastic surgery

yes Yes Yes yes

As per norms of Nursing Council As per norms of Nursing Council As per norms of Nursing Council part of hospital

f. Physiotherapist

g. Psychologist

h. Medicosocial worker

Yes Yes Yes

D ;part of hospital D ;part of hospital D ;part of hospital

4 Equipment

a. Therapeutic

Basic OT instrument;Special instrument for cleft Surgery,hand surgery,Burn reconstructive surgery,Other instruments as per facility service

M-Mandatory

b. Emergency

c. Sterlizing

d. Drugs, Medical devices and consumables e. List of disposables

f. Annual Maintenance records of equip

yes Yes Yes Yes Yes

As per Hospital Document M

5 Support Service

e. sterlization/CSSD

g. Medical Gas/Manifold

h. Blood storage unit/blood Bank i. Amb service

Yes Yes Yes Yes

M-mandatory; part of hospital M-mandatory; part of hospital M-own/outsourced/Tie up M-own/outsourced/Tie up

Template for Minimum standards for Clinics/Polyclinics

ONLY CONSULTATION

DAY CARECENTRE

Remarks

1 Definition

2 Scope

Specialist

Services Provided

Only consultation

All day care procedures of specialty

No liposuction/lipolysis without plastic surgeon at beauty clinic.

3 Physical Infrastructure a.Space requirement

i) Reception

ii) consultation/waiting area

Yes Yes

M-Mandatory M-Mandatory

4 Human resources

Doctors

Tech staff

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff

MCh /DNB Plastic Surgery

MCh /DNB Plastic Surgery NURSE-1

Attendant-1

Yes

M-Mandatory D-Desirable D-Desirable M-Mandatory D-Desirable

5 Equipment

a.Stethoscope

b.Thermometer

c. BP Apparatus

d. Glucometer

e.Weigh machine

f. Emergency kit and medicine

g. Drugs,Medical devices and consumables

Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes* Yes*

M-Mandatory

M (Non Mercury)

M-Mandatory

Refer to Clinic/Polyclinic document *M-Mandatory

h. List of disposables

i. Annual Maintenance records of equip

Yes Yes

Yes* Yes*

*M-Mandatory *M-Mandatory

CLINIC WITH PLASTIC SURGEON

Female Attendent

Attendant-1 Yes

yes

6 support services

a. sterlization/CSSD Yes Yes b. security Yes Yes c. BMW management Yes Yes d. Laundry Yes Yes

if required

D: Desirable

As per BMW Rules

D -Desirable;own/outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients Yes Yes

M-Mandatory

while examining especially females

b. Infection control practices Yes Yes soap and water Yes Yes facilities for hand washing and disinfection Yes Yes

M-Mandatory M-Mandatory M-Mandatory

Disinfection of work Area Yes Yes Use of disposable services Yes Yes small autoclave Yes Yes c. Policy on outsourced services Yes Yes

M-Mandatory M-Mandatory M-Mandatory D

Template for Minimum standards for Hospital

BASIC (General purpose) NON INVASIVE

INVASIVE

Remarks

1 Scope

providesresuscitationandshortterm cardiologyinterventions(eg. Cardio respiratory support including General Hospital with Single defibrillation: require to ventilate for Specialities/Multiple Specialities 24to48hrs.(eg.GeneralHospitalwith exampleCHCSDH,DH,Civil

invasiveproceduresrequiring ICU care with long term acute care of highest standard

Services Provided

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

yes

2 Human resources 2.1 Doctors

MD/DNB Medicine

DM /DNB Cardiology MD/DNB Medicine MBBS doctors to provide the clock Medical cover

DM/DNB Cardiology

M-Mandatory M-Mandatory

Duty Doctors

MBBS doctors to provide clock Medical cover

round

the

round

MBBS doctors to provide round the clock Medical cover

2.2 Nurses General nurses Trained Nurses for ICU/OT/HDU

yes

Yes

Nurse Station:one ECG lead from each patient and as well as relevant haemodynamic and respiratory data should continuouslybepresentoncentral screen

Yes

Nurse Station:one ECG lead from each patient and as well as relevant haemodynamic and respiratory data should continuouslybepresnton central screen

M-Mandatory M-Mandatory

2.3 Pharmacist

Yes Yes

Yes Yes*

M-mandatory,part of hospital

2.4 Para Medical staff a. Lab Tech

*M-EmergencyLab; part of hopital

Single Specialities/Multiple Specialities exampleCHCSDH,DH,CivilHospital, Private Hospital, Nursing Home etc )

Hospital,Private Hospital,Nursing Home etc)

CARDIOLOGY SERVICES IN HOSPITAL

yes yes yes

b. Xray Technician Yes

Yes Yes* *M-own for invasive cardiology; others D-

c.Technician

TrainedcathLabTechnician* *M-ownforinvasive cardiology

d. ECG Technician Yes e. Dietician Yes f. Physiotherapist Yes g. Medicosocial worker

Yes* Yes* *M-Mandatory Yes Yes* *M-Mandatory Yes Yes* *M-Mandatory

3 Equipment

a. Therapeutic

Patient monitoring unit,with 2 ECG channels,invasive pressure channel,non-invasive blood pressure monitor,Sao2 meter 50% beds -5 ECG channels,2 additional haemodyanamic channel,end tidal CO2,Non invasive cardiac output,thermometer.

Yes D-Desirable

Other equipment: Volumetric pump/automatic syringe,Mechanical respirators 1 machine/2 beds ,Intra aortic balloon pump,haemodialysis and haemofiltration machine, pacemaker, defibrillator,external pacemaker , temporary pacemaker ,mobile echocardiography,with TEE probe,blood clot meter,mechanical compressor device for groin and radial haemostatis

own/outsourced

b.Diagnostic

ECG machine TMT,Holter

Xray system for fluroscopy,digital cardiac mobile C arm,-A fully equipped Cardiac Cath Lab

Yes

M-Mandatory

c. Emergency

Yes Yes

Refer to Document on Hospital M-mandatory Refer to Document on Hospital M-mandatory M-mandatory

d. Sterlizing

e. Drugs,Medical devices and consumables

f. List of disposables

g. Annual Maintenance records of equip

Yes Yes Yes Yes

Yes Yes

5 Support Service

a. Laboratory

yes yes

Biochemical markers kits, for MI, Can be own or Glucose level measurement kit, Outsourced Blood gases and electrolyte

analyser

b. Imaging

yes yes

Yes* *M-own for invasive; others

c. sterlization/CSSD

d. Medical Gas/Manifold

Yes Yes Yes Yes Yes Yes

own/outsourced Yes M-own

e. Blood storage unit/ blood Bank

f. Amb service

Yes M-mandatory

Yes M-own/outsourced

Yes Yes Yes Yes

Yes Yes

Yes* *M-CCU Ambulance for invasive/ non invasive cardiology

service centres

1 Definition

2 Scope

Specialist consultation services

Template for Minimum standards for Clinics/Polyclinics

Minimum Standards

Remarks

Services Provided

MD Medicine can provide consultation services but signage of Cardiology not allowed

3 Physical Infrastructure

a. Space requirement

i). Reception

ii). consultation/waiting area iii). OPD Area

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

4 Human resources

a. Doctors

(MD Medicine can provide Cardiology Services but signage not allowed)

b. Tech staff

c. Non Tech staff

d. Duty and salary roster

ECG Tech yes

Yes

D D-Desirable

e. OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK

UPS

5 Equipment

a. Stethoscope

b. Thermometer

c. BP Apparatus

d. Glucometer

e. Weighing machine f. Others

Yes

ECG Machine* ,ECHO,TMT Holter

M-Mandatory

CLINIC WITH CARDIOLOGY SERVICES

DM/ DNB Cardiolology

Yes (Non Mercury)

M-Mandatory

*M-Mandatory others are desirable and can be own/outsourced

g. Drugs,Medical devices and consumables clopid,Aspirin,others h. List of disposables M

i. Annual Maintenance records of equip Yes

Refer to document of Clinic/Polyclinic M

D-Desirable

6 support services

a. security Yes b. BMW management Yes c. Laundry Yes

D-Desirable;Own or outsourced M-Mandatory

D-Desirable;Own or outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while Yes examining especially females

b. Infection control practices Yes soap and water Yes

M-Mandatory

facilities for hand washing and disinfection Yes Disinfection of work Area Yes Use of disposable services Yes small autoclave Yes facilities for sterlization Yes c. Policy on outsourced services Yes

If applicable D

DENTAL SET UP -STAND ALONE/HOSPITAL SET UP (Also refer Annexures for Dental CE)

MinimumStandardsforDentalSetup Stand alone Centre

Multispeciality

Hospital set up Remark

1 Each Category of Dental clinic will be defined on the basis of services provided and basic facilities available.

Dental Chair cum unit-1

3 Dental Chair cum unit

1-5 Dental Chair cum unit

2 Scope of Services

Examination, diagnosis and treatment of all the diseases of teeth and oral cavity

Yes

3 Physical Infrastructure

Name of the dental surgeon incharge with qualification and registration

BDS/MDS

MDS

BDS,MDS M

Timings of the Dental Consultation/Fee structure: To be

Yes Yes

Yes M Yes M

displayed separately

Safety signages : fire safety and Biomedical Waste

Space requirement for waiting room, consulting room and treatment room, safe drinking water

Yes

Yes M Yes For every additional M

Furniture & Fixtures

Yes

Yes M

Yes (As per scope of service) Minimum 100 square feet

Yes For every additional chair the usable carpet area must be increased by 50 % Thereshouldbeadequate space between two dental units enough for patient privacy, ease of movement of staff and proper sanitization.

chair the usable carpet area must be increased by 50 % There should be adequate space between two dental units enough for patient privacy, ease of movement of staff and proper sanitization.

Communication system – Landline/ mobile number for appointment/ internet access

Electrical facilities

Yes Yes

Yes

Qualification of Incharge dental

Yes Yes BDS/MDS BDS/MDS

Yes BDS/MDS

M M

surgeon

4 Human Resource (Full time/Part time/Visiting)

Trained Chairside assistant, Dental Technician(Trained Academically/Clinically)

1Assistant/DentalNurseperChair1Assistant/DentalNurseper 1Assistant/DentalNurse

M M

Minimum Dental Equipments with accessories

Dental Chair Cum Unit,RVG/Dental Xray unit

Dental Chair Cum Unit,RVG/DentalXrayunit

Payment/Roster of salary of staff

Yes Yes

M M

Periodic health check up and vaccination against Habatatis B for doctor and staff

5 Equipment(/ instruments/ drugs

Please see annexure 3 D – Own/Outsour ced

Dental X-Ray Sterilization equipments

RVG Autoclave

RVG/OPG Autoclave

M; Autoclave should be periodically calibrated

Chair

per Chair

List of Consumables and disposables required

Annual Maintenance protocol for equipment and its record of maintenance

Yes

Receptionist

Yes Yes

D M

6 Support Service

Registration with State pollution

control board for BMW 1998

7 Legal/Statutory Requirements

Out and In patient records with names, addresses, Diagnosis and treatments given Site, Space is as given in annexure 1 (for Dental Clinical Establishments), Location and environmental requirements to take into account local bye laws

Yes

Space : D

All restoration Materials, Endodontic material,all material for extraction of mobile and semi mobile teeth,all material for scaling and polishing fissure,sealant and fluoride

All restoration Materials, Endodontic material,all material for extraction of mobile and semi mobile teeth,allmaterialforscaling andpolishingfissure,sealant and fluoride All instrumentandmaterialsfor minorperiodontalsurgery, Allmaterialfororalsurgery, like impaction, apicoectomy, implant placement,reduction of simplefractures

All restoration Materials, Endodontic material,all material for extraction of mobile and semi mobile teeth,all material for scaling and polishing fissure, sealant and fluoride All instrument andmaterialsforminor periodontal surgery, All materialfororalsurgery, like impaction, apicoectomy ,implant placement, reduction of simple fractures

7 Record Maintenance and reporting

Yes M Medicolegal records, as applicable Yes Yes Yes

Confidentialty of Medical records Yes Yes

Record keeping of personnel working Yes Yes in dental clinic indicating their details

including qualification and training

Yes M

Duration of record maintenance: Yes Yes

Yes M

As per the Acts and Rules in force

8 Standards on basic processes

Infection Control practices including Yes Yes Biomedical Waste management

Safety considerations- Yes Yes

Yes M

Annual Maintenance protocol for Yes Yes equipment and its record of

maintenance

Patient Information and Education Yes Yes

Yes M Yes D

M-Mandatory D-Desirable

Yes M

MinimumstandardsforHospital

BASIC (General purpose)

ADVANCE (Non Teaching)

Remarks

1 Scope

Skin Diseases , Skin surgeries (Biopsy) , Nail Surgeries,Electrocautery/Radiofrequency),LASER TREATMENT

Skin Diseases , Skin surgeries, LASER TREATMENT;all advanced dermatology procedures

Services Provided

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality

Yes

2 Human resources 2.1 Doctors

Med person incharge

MD/DNB/DIPLOMA DERMATOLOGY

MD/DNB /DIPLOMA DERMATOLOGY

M ; indoor full time Dermatologist / on visiting basis

Duty Doctors

MBBS doctor for round the clock medical cover

also MBBS-1 (with 6 months house job in Dermatology)

M; part of Hospital

2.2 Nurses

General nurses

Trained Nurses for ICU/OT/HDU

Yes Yes

M; part of Hospital M; part of Hospital

2.3 Pharmacist

Yes

Yes*

*M; in advance dermatology hospital

2.4 Para Medical staff a.Lab Tech

DMLT/SMEAR TECHNICIAN

DMLT/ SMEAR TECHNICIAN

M-Mandatory; part of Hospital

b.X-ray Technician c.Dietitician d.Physiotherapist

Yes Yes Yes

part of Hospital

D; part of Hospital D; part of Hospital

DERMATOLOGY SERVICES IN HOSPITAL

Yes Yes

M.D. Dermatology, D.V.D, D.N.B Dermatology. LASERSurgeriesincludingChemicalPeelscan be performed only by a registered M.D./ DNB/ Diploma holders in Dermatolgy with a certificate of training from recognised institution for 6 months duration (as part of MD Training )

Addtion of 6 months training in advanceDermatologyaspartofMD to be considered by MCI

e.Psychologist Yes

Yes Yes*

MIFPSYCHIATRIST;partofHospital *D; part of Hospital

f.Medicosocial worker No

3 Equipment

a. Therapeutic yes

Microdermabrader , Dermabrader, Phototherapy (Desirable), LASER Electrocautery/ Radiofrequency

as required for Biopsy procedures, Microscope, Dark Ground Microscope narrow band or phototherapy chamber facility for Autoclaving

b. Surgical yes c. Diagnostic yes

D M

d. Emergency yes e.Sterilizing yes f. Drugs, Medical devices and yes consumables

M M

g. List of disposables yes h. Annual Maintenance records yes of equipment

Biopsy punch PUVA therapy optional yes

M M

4 Support Services

4.1. Laboratory Yes 4.2. Imaging Yes 4.3. Pharmacy Yes 4.4. sterlization/CSSD Yes 4.6. Medical Gas/Manifold Yes 4.7. Blood storage unit/blood Yes Bank

Yes Yes Yes* Yes Yes* Yes

own / Outsourced own / Outsourced *M

4.8. Amb service Yes

Yes*

M-Mandatory D-Desirable

Chemical Peels*, Stains for microbiological examination, CO2 laser*

Also refer to documents on

* D hospital

*M D

Template for Minimum standards for Clinics/Polyclinics

Dermatology Clinic

CosmetologycentrewithDermatologist

Remarks

1 Definition

2 Scope

Specialist Specialist

Services Provided

Consultation services, skin biopsy,warts ,

electrocautery, RFA, Nail biopsy,ingrowing Dermabrasion nail excision

3 Physical Infrastructure

a. Space requirement i.Reception

ii. consultation/waiting area

Yes Yes

M-Mandatory M-Mandatory

4 Human resources

Doctors

MD/DNB/DIPLOMA DERMATOLOGY

MD/DNB/DIPLOMA DERMATOLOGY with 6 months training from a recognised centre

ATTENDANT

M-Mandatory

Non Tech staff

Duty and salary roster OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS

ATTENDANT Yes

Yes

Yes Yes

M-Mandatory M-Mandatory M-Mandatory

5 Equipment

a. Stethoscope b. Thermometer c. BP Apparatus

M-Mandatory

Yes

Yes (Non Mercury) No Yes (Non Mercury) No

DERMATOLOGY CLINIC

Consultation, Laser treatment ,

Dermatologists providing Cosmetology services must have certificate from Govt. recognised centres. No chemical or laser permitted without dermatologist at beauty clinic. No liposuction/ lipolysis without plastic surgeon at beauty clinic.

d. Glucometer Yes

e. Weighing machine Yes

f. Other ELECTROCAUTERY/RFA-ESSENTIAL

LASER,CHEMICAL PEEL-DESIRABLE

D-Desirable M-Mandatory D-Desirable

DESIRABLE g.Emergency kit and medicine Yes

Refer to document on clinic/Polyclinic

h. Drugs,Medical devices and Yes* consumables

*M-Mandatory

i. List of disposables

j. Annual Maintenance records of equip

Yes Yes

M-Mandatory M-Mandatory

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Autoclave Yes

Yes

Autoclave Yes

Yes

D-Desirable M-Mandatory

own or outsourced

7 Standard on basic processes a. Receiving patients,privacy for patients whileexamining especially females

Yes

M-Mandatory

b. Infection control practices soap and water

Yes Yes Yes

M-Mandatory M-Mandatory M

facilities for hand washing and disinfection

Disinfection of work Area

Yes Yes Yes Yes

M D-Desirable

Use of disposable services small autoclave

c. Policy on outsourced services

PHOTOTHERAPY,LASER,CHEMICAL PEEL-

1 Definition

2 Scope

Specialist

5 Equipment

Minimum standards for Clinics/Polyclinics

Minimum Standards

Remarks

Services Provided

Consultation services/Councelling services

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

M-Mandatory M-Mandatory

4 Human resources

Doctors

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff

MD/DNB/DIPLOMA in Dermatology, Venerology and Leprosy ATTENDANT

Yes

M-Mandatory D-Desirable M-Mandatory M-Mandatory

a. Stethoscope

b. Thermometer

c. BP Apparatus

d. Glucometer

e. Weigh machine

f. Emergency kit and medicine

g. Drugs,Medical devices and consumables h. List of disposables

Yes Yes Yes Yes Yes Yes Yes Yes Yes

M(Mercury free)

Refer to document on Clinic/Polyclinic M

M-Mandatory

i. Annual Maintenance records of equip

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Autoclave Yes

Yes

Autoclave

M-Mandatory

own or outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while examining especially females

b. Infection control practices

Yes

M-Mandatory

c. soap and water

d. facilities for hand washing and disinfection e. Disinfection of work Area

Yes Yes Yes Yes Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory D

f. Use of disposable services

g. small autoclave

h. Policy on outsourced services

STD CLINIC

1 Scope

only Gastroscopy and COLONOSCOPY Yes

all other advanced procedure of Gastroenterology also

MinimumstandardsforHospitalunderCEA

Basic (General Purpose)

Advance (Non Teaching )

Remarks

Services Provided

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

Yes Yes Yes

2 Human resources 2.1 Doctors

Med person incharge

MD /DNB (MEDICINE) / PAEDIATRICS with certified training of six months in endoscopy

MBBS Doctor for round the clock Medical cover

DM/DNB in Gastroenterology

M-Mandatory

Duty Doctors

MBBSDoctorforroundtheclock Medical cover

M-Mandatory in inpatient

part of hospital AS PER NURSING COUNCIL

2.2 Nurses Nursing head

Yes Yes Yes Yes Yes Yes

Yes

General nurses

Trained Nurses for ICU/OT/HDU

Yes

AS PER NURSING COUNCIL

AS PER NURSING COUNCIL D-Desirable

2.3 Pharmacist

2.4 Para Medical staff a.Lab Tech

Yes

b.Xray Technician

Yes

c.Technician d.ECG Technician

Any Trained Technician Yes

GE trained Technician Yes

GASTROENTEROLOGY SERVICES INHOSPITAL

Yes

M-Mandatory ;if own lab services M-Mandatory; if own services M-Mandatory

e.Dietician f.Physiotherapist g.Medicosocial worker

Yes* Yes* No

Yes** Yes** Yes

*Desirable **-Mandatory *-Desirable **-Mandatory D-Desirable; in advance

3 Equipment

a. Therapeutic b. Surgical

Gastroscope, colonoscope

equipment for advanced Gastroenterology, EU scope with digital fluoroscope

Cardiac monitor,defibrillator and accessories,sengstaken tube

M-Mandatory

c. Diagnostic d. Emergency

Yes Yes

M-Mandatory

Refer to document on Hospital M-Mandatory

Refer to document on Hospital M-Mandatory M-Mandatory

e. Sterlizing

f. Drugs,Medical devices and consumables

Yes

Emergency Drugs, Terlipressin

Yes

Emergency Drugs, Terlipressin, Sengstaken tube

Yes

g. List of disposables

h. Annual Maintenance records of equip

Yes Yes

4 Support Services

4.1. Pharmacy

4.2. sterlization/CSSD

4.4. Medical Gas/Manifold

4.5. Blood storage unit/blood Bank 4.6. Amb service

Yes Yes Yes Yes Yes

Yes* Yes Yes Yes Yes

*M-IN ADVANCE M-Mandatory

M-IN ADVANCE D-Desirable

M-own /outsourced / TIE UP

M-Mandatory

Minimum standards for Clinics/Polyclinics

Minimum Standards

Remarks

1 Definition

2 Scope

Specialist

Services Provided

PROVIDING GASTROENTEROLOGY CONSULTATION SERVICES/BASIC PROCEDURES (Gastroscopy & Colonoscopy)

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area iii. OPD Area

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

4 Human resources

Doctors

DM /DNB GASTROENTEROLOGY ;MD (Med/Paeds) with certified training of 6 mths in endoscopy

M-Mandatory

Tech staff

Non Tech staff

Duty and salary roster OTHERREQUIREMENTLIKEPERIODICHEALTH CHECK UPS,vaccination of staff

Nurses 3-4 Attendant Yes

Yes

M-Mandatory M-Mandatory M-Mandatory D- Desirable

5 Equipment

a. Stethoscope

b. Thermometer

c. BP Apparatus d. Glucometer

e. Weight machine

Yes

yes Gastroscope,Colonoscope

M-Mandatory

Yes (Non Mercury) Yes (Non Mercury) M-Mandatory M-Mandatory O-Optional

CLINICS WITH GASTROENTEROLOGY SERVICES

f. Emergency kit and medicine

cardiac monitor,defribrillator and accessories,

Also Refer to document on clinic/polyclinic

g. Drugs,Medical devices and consumables h. List of disposables

i. Annual Maintenance records of equip

Yes Yes Yes

M-Mandatory

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Autoclave Yes

Yes

D- Desirable M-Mandatory

own or outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while examining especially females

b. Infection control practices

soap and water

facilities for hand washing and disinfection

Yes

Disinfection of work Area

Use of disposable services facilities for sterlization

c. Policy on outsourced services

Yes Yes Yes Yes

M-if applicable D

Yes Yes Yes

M M M

Minimum standards for Hospital

Minimum Standards (Non Teaching)

Remarks

1 Scope

All G I Surgeries; Also diagnostic gastroscopy, colonoscopy, sigmoidoscopy, Oesophageal stricture dilatation.

Services Provided

Superspeciality

2 Human resources

Yes

2.1 Doctors

Med person incharge

Surgeon should fulfil MCI/DNB guidelines or have one year full time training in GI surgery after getting General Surgery degree

Critical care specialist/Intensivist in ICU-1

Duty Doctors

2.2 Nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

2.4 Para Medical staff

a.Lab Tech

b.Xray Technician

c.OT Technician

d.ECG Technician

e.Dietitician

f.Physiotherapist

g.Psychologist

h.Medicosocial worker

MBBS Doctors for round the clock medical cover

M-Mandatory M-Part of Hospital

3 Equipment

a. Therapeutic b. Surgical

ABG machine is must,no other special equipment Surgical Tray set

M-Mandatory M-Mandatory

GI SURGERY SERVICES IN HOSPITAL

Yes Yes

1per2beds M-Mandatory

Yes Yes Yes Yes Yes Yes Yes Yes

M- if own lab;part of hospital M- if own;part of hospital M-Mandatory

M-Mandatory

M-Mandatory M-Mandatory D-Desirable D-Desirable

c. Diagnostic

d. Emergency

e. Sterlizing

f. Drugs,Medical devices and consumables

Yes as applicable

Yes Refer document of hospital Yes M-Mandatory

Yes Refer document of hospital

g. List of disposables

h. Annual Maintenance records of equip

Yes M-Mandatory Yes D-Desirable

4 Support Services

a. Laboratory b.Imaging

Yes own or Outsourced PortableUSGmachinewithaqualifiedRadiologistavailable M-Mandatory

on call

Yes M-Mandatory

c.Pharmacy

d. sterlization/CSSD

e. Medical Gas/Manifold

f. Blood storage unit/blood Bank g. Amb service

Yes M-Mandatory

Yes M-own/outsourced/TIE UP Yes M-own/outsourced/TIE UP

Template for Minimum standards for Clinics/ Polyclinics

Minimum Standards

Day Care

Remarks

1 Definition 2 Scope

Specialist

Services Provided

Only consultation services;minor procedure

Day Care Procedures:

1. DiagnosticsBiopsies(US guided/

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

Yes M Yes M

4 Human resources

Med person incharge

MCh/DNB(GISurgery)/MSGeneralSurgerywith3 years of experience in recognised GI Surg Department)

MCh/DNB(GISurgery)/MSGeneral M Surgery with 3 years of experience in recognised GI Surg Department)

Tech staff

Non Tech staff

Duty and salary roster

NURSE-1 Attendant Yes

yes

NURSE-1 M-Mandatory Attendant M

Yes M-Mandatory yes D-Desirable

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff

CLINIC FOR GI SURGERY

Endoscopic)

2. Endoscopic- Diagnostic/Therapeutic/UGI

Colonoscopy, UGI scopy with stricture

dilatation

3. Protoscopic procedures- Haemorrhoidal

band ligation/sclerotherapy,fistula threading/wiring underLA

5 Equipment

a. Stethoscope

b. Thermometer

c. BP Apparatus

d. Glucometer

e. Weigh machine

f. Emergency kit and medicine

Yes Yes Yes Yes Yes yes

Yes

g. Drugs,Medical devices and consumables

Yes–2 rigid proctoscope with single light source,Haemorrhoidal band applicator device,punchbiopsyforcep,dressingset, specimen vial. (short stay facility)

Yes–2 rigid proctoscope with singlelightsource,Haemorrhoidal band applicator device,punch biopsy forcep,dressing set,specimen vial.Sigmoidoscope-

h. List of disposables

Yes Yes

M D-Desirable

i. Annual Maintenance records of equip

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Yes Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory Own/outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while

Yes

M-Mandatory

examining especially females b. Infection control practices

Yes Yes Yes Yes Yes Yes Yes Yes

M D-Desirable

soap and water

facilities for hand washing and disinfection Disinfection of work Area

Use of disposable services

small autoclave

facilities for sterlization

c. Policy on outsourced services

Yes (Non Mercury)

Refer to document on clinic/Polyclinic

Minimum standards for Hospital

<30 beds

>30 beds

Remarks

1 Scope

General Surgery Services

Emergency OT-1 (dedicated); with round the clock service

Services Provided

1.1General purpose 1.2.Single Speciality 1.3.Multispeciality

Yes Yes Yes

Yes Yes

2 Human resources 2.1 Doctors

Med person incharge

MS/DNB GEN SURG-1/OT JUNIOR SURGEON-1 DESIRABLE

MS GEN /DNB SURG-3, SENIOR Surgeon -1*

JUNIOR SURGEON-1** DESIRABLE

Duty Doctors

MBBS1

MBBS Doctor for round the clock Medical Cover

MBBS1

MBBS Doctor for round the clock Medical Cover

M-Mandatory M-Mandatory;part of hospital

2.2 Nurses

Nursing head

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

2 Yes

Yes Yes Yes

part of hospital part of hospital part of hospital part of hospital

2.4 Para Medical staff a.Lab Tech

b.Xray Technician c.OT Technician d.ECG Technician

Yes

Yes (own/outsource)

Yes Yes Yes Yes

M- if own lab M- if own

M D-desirable

GENERAL SURGERY IN HOSPITAL

*M-Mandatory **D

e.Dietician f.Physiotherapist g.Psychologist h.Medicosocial worker

Yes Yes Yes No

Yes* Yes* Yes Yes

*M D-desirable D-desirable

3 Equipment

a. Therapeutic

Surgical tray

Surgical Tray

M-NUMBER AS REQUIRED

b. Emergency

Yes

Refer to document on Hospital M-Mandatory

Refer to document on Hospital M-Mandatory D-desirable

c. Sterlizing

d. Drugs,Medical devices and consumables

Yes Yes

d. List of disposables

Yes Yes

e. Annual Maintenance records of equip

4 Support Services

4.1. Laboratory

4.2. Imaging

4.3. Pharmacy

4.4. sterlization/CSSD 4.5. Medical Gas/Manifold

Yes Yes Yes Yes Yes

Yes Yes Yes* Yes Yes

own or Outsourced own or Outsourced *M

4.6. Blood storage unit/blood Bank 4.7. Amb service

Yes Yes

Yes* Yes

M- own/ Outsourced/ Tie up

Minimum standards for Clinics/Polyclinics

ONLY CONSULTATION

With minor OT

Remarks

1 Definition 2 Scope

Specialist

Services Provided

SURGICAL CONSULTATION, PROCTOSCOPY, DRESSING, needle aspiration, DRE

SUTURING, SUTURE REMOVAL, ABSCESS DRAIN, EXCISION LYMPH NODE BIOPSY, DEBRIDEMENT, BANDING, PARACENTESIS, CATHETERIZATION, NEEDLE ASPIRATION, FNAC, MINOR PROCEDURE WHERE NO GA IS REQUIRED

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area iii. OPD Area

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

4 Human resources

Med person incharge Technician

Non Tech staff

MS /DNB GEN SURG Nurse*

Attendant-1*

MS /DNB GEN SURG TRAINED TECHNICIAN-1** Attendant-1**

M-Mandatory

**M;*D

**M;*D;in only consultation clinic either Nurse or Attendant D-

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff

Yes Yes

M-Mandatory D-Desirable

GENERAL SURGERY CLINIC

5 Equipment

a. Stethoscope

b. Thermometer

c. BP Apparatus

d. Glucometer

e. Weigh machine

f. Emergency kit and medicine

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes (Non Mercury) Yes (Non Mercury) M

g. Drugs,Medical devices and consumables

Yes

M-Mandatory

h. List of disposables

i. Annual Maintenance records of equip

Yes Yes

M-Mandatory D

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Yes Yes Yes Yes

M-Mandatory

Own/ outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients whileexaminingespeciallyfemales

Yes

b. Infection control practices soap and water

Yes Yes Yes

M M-Mandatory

facilities for hand washing and disinfection

Disinfection of work Area Use of disposable services

Yes Yes Yes Yes Yes

M-Mandatory M

M D-Desirable

small autoclave

facilities for sterlization

c. Policy on outsourced services

DRESSING TRAY, CATHETERISATION TRAY, PORTABLE LIGHT

DRESSING TRAY, CATHETERISATION Refer to document on

TRAY, PORTABLE LIGHT

clinic and Polyclinic

1 Scope

General Medicine Services FNAC, PLEURAL TAP, ASCITIC TAP

Services related to Geriartic Care

Minimum standards for Hospital

MEDICINE

GERIARTIC

Remarks

Services Provided

1.1 General purpose 1.2.Single Speciality 1.3.Multispeciality

Yes Yes yes

Yes Yes

2 Physical Infrastructure

ICU Beds

Distance between 2 beds Windows

Physiotherapy Unit

Toilet

20% of Medical and surgical ICU

M M M D M

3 Human resources 3.1 Doctors

Med person incharge

MD/DNB MEDICINE/MD/DNB Medicine

or MD/DNB

Duty Doctors

3.2 Nurses

Nursing head

General nurses

Trained Nurses for ICU/OT/HDU 3.3 Pharmacist

MBBS-2

MBBS Doctors for round the clock service

MDGERIARTICMEDICINE-1/ MEDICINE-1

MBBS-4 for 10 BEDS

MBBS Doctors for round the clock service

part of Hospital

3.4 Para Medical staff a.Lab Tech

b.Xray Technician c.ECG Technician

Yes Yes Yes

M- if own lab

M- if own M;own/outsourced service

d.Dietician e.Physiotherapist f.Psychologist g.Medicosocial worker

Yes Yes Yes yes

Yes Yes Yes Yes

M-in >30 beds D

MEDICINE AND GERIARTIC SERVICES IN HOSPITAL

Yes

1 per 2 beds Yes

Yes

1per 2 beds Yes

Part of Hospital

General Ward: 1.8 m, ICU Ward: 2.5 m

20% of room area (for lighting and ventilation) 100 sq. m

One closet for every 8 patients

4 Equipment

Emergency

Yes

Refer to document on hospital

Sterlizing

Drugs,Medical devices and consumables

Yes Yes

Refer to document on hospital

List of disposables

Annual Maintenance records of equipment

yes Yes

M for major equipments

5 Support Services

5.1. Laboratory

5.2. Imaging

5.3. Pharmacy

5.4. Medical Gas/Manifold 5.5.Blood storage unit/blood Bank 5.6. Ambulance service

Yes Yes Yes Yes Yes Yes

Yes

Services related to Geriartic Care

own or Outsourced own or Outsourced M;own/outsourced M

M- Mandatory

D- Desirable

M-own/ outsourced/ TIE UP

Minimum standards for Clinics/ Polyclinics

MEDICINE

GERIARTIC

REMARK

1 Definition

2 Scope

Specialist

Services Provided

CONSULTATION SERVICES; care of acute and chronic illnesses,referral services,basic preventive services

3 Physical Infrastructure a. Space requirement

GROUND/ LIFT FACILITY*; adequate space for wheel chair bound or disabled patient

i. Reception

ii. consultation/ waiting area

Yes Yes

M M

4 Human resources

Med person incharge

MD/DNB MEDICINE

MD Geriatric Medicine/ MD/ DNB Medicine

ATTENDANT-1

Yes

Non Tech staff

Duty and salary roster OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS, vaccination of staff

ATTENDANT-1 Yes

Yes

M M D

5 Equipment

a. Stethoscope

b. Thermometer

c. BP Apparatus d. Glucometer

e. Weight machine Portable X-ray

Yes Yes Yes Yes Yes Yes

Yes (Non Mercury) Yes (Non Mercury) M

MEDICINE AND GERIARTIC CLINIC

Ultrasound Yes Yes

Refer document of clinic/polyclinic

f. Emergency kit and medicine

Yes Yes

g. Drugs,Medical devices and consumables

h. List of disposables

i. Annual Maintenance records of equip

Yes Yes

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Yes Yes Yes Yes Yes Yes Yes Yes

M D-Own/outsourced

7 Standard on basic processes a. Receiving patients,privacy for patients while examining especially females

Yes Yes

b. Infection control practices soap and water

Yes Yes Yes Yes Yes Yes

M M M

facilities for hand washing and disinfection

Disinfection of work Area Use of disposable services

Yes Yes D D Yes Yes Yes Yes

M M M D

small autoclave

c. Policy on outsourced services

Yes Yes Yes Yes

M D

M- Mandatory D- Desirable

Template for Minimum standards for Hospital under CEA

Endocrinology with Endocrinology Surgery

Remarks

1 Scope

Services Provided 1.1 Single Speciality 1.2. Multispeciality 1.3. Superspeciality

Related to Endocrine diseases

2 Human resources 2.1 Doctors

Med person incharge

DM /DNB Endocrinology Mandatory)

(M- M.Ch /DNB Endocrinology surgery (D- Desirable)

only very few institutes giving MCh Endocrinology surgery Neurosurgeon/ENT Surgeons/General surgeons can also do the endocrinal surgeries.

Full time consultant Part time consultant visiting consultant Duty Doctors

Yes Yes Yes Yes

MBBS Doctors for round the clock Medical cover

2.2 Nurses General nurses

Yes Yes

Yes 1forOT

M-Mandatory M-Mandatory

Trained Nurses for ICU/OT/HDU

2.3 Pharmacist

Yes

M;part of Hospital

ENDOCRINOLOGY SERVICES IN HOSPITAL

yes ( Beds Optional ) yes

yes

yes (Min 2 beds)

2.4 Para Medical staff a.Lab Tech

b.Xray Technician c.OT Technician d.ECG Technician e.Dietician f.Physiotherapist g.Psychologist h.Medicosocial worker

Yes Yes

1 Yes Yes Yes yes yes Yes Yes

M- if own lab M- if own M-Mandatory M-Mandatory M-Mandatory D-Desirable D-Desirable D-Desirable

3 Equipment

Emergency

Yes

Refer to documents on Hospital

Sterlizing

Drugs,Medical devices and consumables

List of disposables

Annual Maintenance records of equip

Yes Yes

M-Mandatory

Refer to documents on Hospital

4 Support Services

4.1. Laboratory

Hormonal estimation lab,Dexa lab, BMD-Tie up

Yes

Hormonal estimation lab,Dexa lab, BMD-Tie up

yes

Yes

own or Outsourced or Tie up

4.2. Imaging

4.3. Pharmacy

4.4. sterlization/CSSD 4.5. Medical Gas/Manifold

Yes Yes

own or Outsourced M-Mandatory M-Mandatory M-Mandatory

Yes yes Yes Yes Yes

Yes Yes

M-Mandatory M-Mandatory

Template for Minimum standards for Clinics/Polyclinics

Diabetology Clinic

Endocrinology clinic

Remarks

1 Definition 2 Scope

General/Specialist

Specialist

Services Provided

providing consultation services for Diabetes

consultation services

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area iii. OPD Area

yes Yes yes

M-Mandatory M-Mandatory M-Mandatory

4 Human resources

Med person incharge

DM /DNB Endocrinology or MD/DNB Diploma / training in Diabetology, both

(M- DM/DNB

Non Tech staff

Duty and salary roster Others

Attendant

Yes Diabeticeducator/Nurseeducator

D-Desirable D-Desirable D-Desirable

OTHERREQUIREMENTLIKEPERIODIC HEALTH CHECK UPS,vaccination of staff

asrequired

D-Desirable

ENDOCRINOLOGY CLINIC

MD/DNB Medicine Medicine/MBBSwithminimumoneyear Mandatory)

from recognised institution Mandatory)

Attendant

Yes Diabeticeducator/Nurseeducator

(M-

Endocrinology Desirable)

(D-

5 Equipment

a. Stethoscope

b. Thermometer

c. BP Apparatus

d. Glucometer

e. Weigh machine

f. Emergency kit and medicine

Yes Yes Yes Yes Yes Yes

Yes (Non Mercury) Yes (Non Mercury)

Refer to documents on clinic/Polyclinic

M-Mandatory D-Desirable

g. Drugs,Medical devices and consum h. List of disposables

Yes Yes Yes

i. Annual Maintenance records of

equip

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Yes

as per policy laid down Yes

Yes

as per policy laid down Yes

D-Desirable own/outsourced

9 Standard on basic processes a.Receiving patients,privacy for patients while examining especially females

Yes

b. Infection control practices soap and water

Yes Yes Yes

M M M

facilities for hand washing and disinfection

Disinfection of work Area

Use of disposable services small autoclave

Yes Yes Yes Yes

M M M D

c. Policy on outsourced services

Template for Minimum standards for Hospital

BASIC (General purpose)

ADVANCE(NonTeachingHospital) REMARK

1 Scope

Providing services for General Hospital with Single Specialities/ Multiple Specialities example SDH, District Hospital, Civil Hospital,Private Hospital,Nursing Home)etc

Providing services for Superspecialities example Civil Hospital, Regional Hospital,Nursing Home,Private Hospital etc.

Services Provided

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

Yes Yes Yes

2 Human resources 2.1 Doctors

Med person incharge

DM/ DNB NEUROLOGY or MD/DNB MEDICINE

Yes or

DM /DNB NEUROLOGY

Full time consultant Part time consultant visiting consultant Duty Doctors

Yes Yes

Yes or

Yes

Yes MBBS Doctors for round the

2.2 Nurses

Nursing head

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

Yes Yes Yes

Yes part of Hospital Yes part of Hospital Yes part of Hospital

2.4 Para Medical staff a. Lab Tech

Yes

Yes M- if own lab

NEUROLOGY SERVICES IN HOSPITAL

Yes

clock cover M

yes, own/outsourced; part of Hospital

b. Xray Technician c.Technician

Yes

*EEG Technician-1 (BSc NEURODIAGNOSIS) Yes

Yes

Yes*

Yes

**EEG Technician-1 (BSc NEURODIAGNOSIS)

Yes

Yes**

Yes*

M- if own *D

**M

d. ECG Technician e. Dietician

f. Physiotherapist g. Psychologist

*D;**M D,*M-Mandatory if Psychiatrist

h. Medicosocial worker

Yes

3 Equipment

Therapeutic Diagnostic Emergency

EEG.EMG Yes

CT Scan

EEG.EMG Yes

CT Scan

Also Refer document on hospital

Refer document on Hospital

Sterlizing

Drugs,Medical devices and consumables

Yes Yes

List of disposables

Yes Yes

M D

Annual Maintenance records of equip

4 Support Services

4.1. Laboratory

4.2. Imaging

4.3. Pharmacy

4.4. sterlization/CSSD

4.5. Medical Gas/Manifold

4.6. Blood storage unit/blood Bank 4.7. Amb service

Yes Yes Yes Yes Yes Yes Yes

own or Outsourced own or Outsourced M-own/outsourced M

M-Mandatory

D- Desirable

M-own/outsourced/TIE UP M-own/outsourced/TIE UP

Template for Minimum standards for Clinics/ Polyclinics

Minimum Standards

Remarks

1 Definition

2 Scope

Specialist

Neurology OPD Consultation

Services Provided

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

M M

4 Human Resources

Med person incharge

Tech staff

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS

DM/DNB NEUROLOGY NURSE-1

Attendant-1

Yes

M D M M D

5 Equipment

a. Stethoscope

b. Thermometer c. BP Apparatus d. Glucometer

e. Weigh machine f. Others

Yes

Yes HAMMER Yes

Yes (Non Mercury)

Refer document of Clinic/Polyclinic; INCLUDE DIAZEPAM , LORAZEPAM M

g. Emergency kit and medicine

h. Drugs,Medical devices and consumables

Yes

i. List of disposables

j. Annual Maintenance records of equip

Yes Yes

M D

Yes

NEUROLOGY CLINIC

6 support services

a. sterlization/CSSD Yes b. security Yes c. BMW management Yes d. Laundry Yes

M own/outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients Yes while

examining especially females

b. Infection control practices Yes

M M M

soap and water Yes facilities for hand washing and disinfection Yes

Disinfection of work Area Yes Use of disposable services Yes small autoclave Yes c. Policy on outsourced services Yes

M M M D

M-Mandatory D- Desirable

Template for Minimum standards for Hospital

BASIC

ADVANCE

Remarks

1 Scope

Providing Basic Neurosurgery services (example SDH, District Hospital, Civil Hospital, Private Hospital, Nursing Home) etc

Providing Neurosurgery services (example Civil Hospital, Regional Hospital, Nursing Home, Private Hospital etc.)

Services Provided

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

Yes yes yes

2 Human resources

Med person incharge Duty Doctors

MCh/ DNB Neurosurgery-1

also MS General SURGEON-3

MBBS Doctors for round the clock cover

MCh/ DNB Neurosurgery-1/6 beds also MS General SURGEON-3

MBBS Doctors for round the clock cover

M M M

2.2 Nurses

Nursing head

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

1 Yes

M- Inhouse pharmacy

2.4 Para Medical staff a. Lab Tech

b. Xray Technician

c. OT Technician

Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes*

M- if own lab M- if own

d. ECG Technician e. Dietician

f. Physiotherapist g. Psychologist

D D D *M

h. Medicosocial worker

Yes

NEUROSURGERY SERVICES IN HOSPITAL

2 2

1 per 3 bed

1 per 1 bed

1 per 50 beds

Yes

3 Equipment

a. Surgical

Basic Surgical Tray/ Open surgery tray /Laproscopy

Basic Surgical Tray/ Open surgery tray/ M Laproscopy/ Equipment for neuro surgery super speciality; C Arm Machine- 1(for intraoperative spinal neurosurgical operations)

b. Diagnostic

EEG,EMG,XRay machine-both portable and fixed-1 for 50 beds/CT Scan 64 Slice -1

EEG,EMG,XRay machine-both portable M andfixed-1for50beds/CTScan64Slice-

c. Emergency

Yes Yes

Refer document of Hospital

d. Sterlizing

d. Drugs, Medical devices and consumables

e. List of disposables

f. Annual Maintenance records of equip

Yes Yes Yes Yes

Refer document of Hospital

4 Support Services

4.1. Laboratory

4.2. Imaging

4.3. Pharmacy

4.4. sterlization/CSSD

4.5. Medical Gas/Manifold

4.6. Blood storage unit/blood Bank 4.7. Amb service

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

own or Outsourced own or Outsourced M

Yes Yes Yes Yes

M D

M-Mandatory

D- Desirable

M-own/outsourced/TIE UP M-own/outsourced/TIE UP

Minimum standards for Clinics/Polyclinics

CONSULTATION SERVICES

REMARK

1 Definition

2 Scope

Specialist

Services Provided

Consultation Services

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

M M

4 Human resources

Med person incharge

Tech staff

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS

M.Ch/ DNB NEUROSURGERY NURSE-1

Attendant-1

Yes

M Optional M

5 Equipment

a. Stethoscope

b. Thermometer

c. BP Apparatus

d. Glucometer

e. Weigh machine

f. Emergency kit and medicine

g. Drugs,Medical devices and consumables h. List of disposables

Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes (Non Mercury)

Refer document clinic / Polyclinic M

i. Annual Maintenance records of equip

6 support services

a. sterlization/CSSD b. security

Yes Yes

M D

CLINIC WITH NEUROSURGERYSERVICES

Yes

c. BMW management Yes

M own/outsourced

d. Laundry Yes 7 Standard on basic processes

a. Receiving patients,privacy for patients while examining Yes especially females

b. Infection control practices Yes

soap and water Yes facilities for hand washing and disinfection Yes Disinfection of work Area Yes

M M M M M M M D

Use of disposable services M small autoclave Yes facilities for sterlization Yes c. Policy on outsourced services Yes

M-Mandatory D- Desirable

Minimum standards for Hospital

BASIC (General Purpose)

Advance

Remarks

1 Scope

Providing services ( example Primary Health Centre, Community Health Centre SDH,District Hospital, Private Hospital,Nursing Home etc)

Providing services (example Civil Hospital, regional Hospital,Nursing Home,Private Hospital of similar scope)

Services Provided

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

Yes

2 Human resources Med person incharge

MD/MS/DGO-1 OR MBBS WITH EMOC TRAINING

YES or

YES OR visiting consultant PAEDIATRICIAN

MD/MS/DGO GYNAE OBS

Full time consultant

YES or

YES OR visiting consultant PAEDIATRICIAN

Part time consultant

Full time/Part time/visiting consultant

Duty Doctors

MBBS Doctors for round the clock service

2.2 Nurses

Nursing head

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

2 Yes Yes

1 M 2 M

2.4 Para Medical staff a. Lab Tech

Yes

M- if own lab;lab can be own/outsourced/Tie up

GYNAECOLOGY AND OBSTETRICS SERVICES IN HOSPITAL

Yes Yes Yes

Yes Yes

As per ICU policy M-own/outsourced

b. Xray Technician

Yes

M- if own ;can be own/outsourced/Tie up

c. OT Technician

d. ECG Technician

e. Dietician

f. Physiotherapist

g. Psychologist

h. Medicosocial worker

yes Yes Yes Yes Yes Yes

Yes* Yes Yes Yes Yes Yes

*M D-Desirable D-Desirable D-Desirable D-Desirable D-Desirable

3 Equipment

Therapeutic Surgical Diagnostic Emergency

Yes

forceps, sims speculum, cusco’s, colposcope, pap smear, endometrial biopsy

Yes

for ECLAMPSIA, POST PARTUM HAEMORRHAGE MGT also

M-Mandatory M-Mandatory M-Mandatory

For others refer to document of hospital

Sterlizing

Drugs,Medical devices and consumables

List of disposables

Annual Maintenance records of equ

Yes Yes

refer to document of

4 Support Services

4.1. Laboratory

4.2. Imaging

4.3. Pharmacy

4.4. sterlization/CSSD

4.5. Medical Gas/Manifold

4.6. Blood storage unit/blood Bank D

Yes

own or Outsourced own or Outsourced M-IN ADVANCE

4.7. Amb service Yes

Yes

own/ outsourced/ TIE UP

Yes Yes

hospital

M D-Desirable

Yes

Yes Yes Yes

Yes Yes Yes Yes*

M-IN ADVANCE *M-Mandatory- own/outsourced/TIE UP

Minimum standards for Clinics/ Polyclinics

GYNAE OPD

GOVT RECOGNISED MTP CENTRES

Remarks

1 Definition 2 Scope

General/Gynaecologist

Services Provided

PAP SMEAR, VIA, VILI, CERVICAL BIOPSY, COLPOSCOPY, VULVOSCOPY,ANC, NORMAL DELIVERY, USG, ANC

PAP SMEAR, VIA, VILI, CERVICAL BIOPSY, COLPOSCOPY, VULVOSCOPY, DELIVERIES, MTP

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

M-Mandatory M-Mandatory

4 Human resources

Doctors

MBBS/MD/MS/DGO GYNAE OBS

MD/MS/DGO GYNAE OBS

Under MTP Act clause Subject to the provisions of sub- section (4), a pregnancy may be terminated by a registered medical practitioner, –

(a) Where the length of the pregnancy does not exceed twelve weeks if such medical practitioner is, or

(b) Wherethelengthofthepregnancyexceedstwelve weeks but does not exceed twenty weeks, if not less than two registered medical practitioner are, of opinion, formed in good faith, that –

(i) the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; or

Tech staff

Non Tech staff

Duty and salary roster OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff

STAFF NURSE-1 ATTENDANT-1 Yes

Yes

STAFF NURSE-2 ATTENDANT-1 Yes

Yes

M D-Desirable

GYNAE AND OBS CLINIC

(ii) there is a substantial risk that if the child were born, it wouldsufferfromsuchphysicalormentalabnormalities to be seriouslyhandicapped.

5 Equipment

Stethoscope Thermometer BP Apparatus Glucometer Weigh machine

Yes

DELIVERY KIT

forceps,sims speculum, cusco’s, colposcope, pap smear,endometrial biopsy

Yes M-Mandatory Yes M

Yes M

Emergency kit and medicine

Yes M

DELIVERY KIT M

ECLAMPSIA,POST PARTUM HAEMORRHAGE MGT alsorefertodocumenton

List of Disposables and Consumables

Yes Yes

Clinic/Polyclinic Yes M

Yes D

Annual maint of equipt

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Yes Yes Yes Yes

Yes M-Mandatory Yes D-Desirable

Yes M

Yes Own/outsourced

7 Standard on basic processes a. Receiving patients,privacy for patients while examining especially females

Yes

Yes M-Mandatory

b. Infection control practices soap and water

Yes Yes Yes

Yes M-Mandatory Yes M-Mandatory Yes M

facilities for hand washing and disinfection

Disinfection of work Area

Yes Yes Yes Yes Yes

Yes M

Yes D-Desirable

Use of disposable services small autoclave

facilities for sterlization

c. Policy on outsourced services

1 Scope

Providing orthopaedics services ( example SDH, District Hospital, Private Hospital, Nursing Home etc)

Providing orthopaedics services (example Civil Hospital, regional Hospital, Nursing Home, Private Hospital of similar scope)

Minimum standards for Hospital

BASIC (General purpose)

ADVANCE

Remarks

Services Provided

1.1.General purpose 1.2.Single Speciality 1.3.Multispeciality

Yes Yes yes

yes Yes

2 Human resources

Medpersonincharge

MS/DNBGENERALSURGorMS/DNB/Diploma MS/DNB/DiplomaORTHOPAEDICS ORTHOPAEDICS

visiting Orthopaedic consultant Duty Doctors

or Yes

also GENERAL SURGEON-2 MBBS-2

or Yes

2.2 Nurses Nursing head General nurses Trained Nurses for ICU/OT/HDU

2 Yes

M M M

2.3 Pharmacist

Yes

Mandatory-in inhouse pharmacy

2.4 Para Medical staff a. Lab Tech

b. Xray Technician

Yes Yes

M- if own lab M-ifown;

c. OT Technician

Yes

ORTHOPAEDIC SERVICES INHOSPITAL

MBBS DOCTORS for round the clock cover from hospital pool

part of Hospital

d. ECG Technician e. Dietitician

f. Physiotherapist g. Psychologist

Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes*

D-own/outsourced D

h. Medicosocial worker 2.5 others

*M M

a. Policy Manpower/ posting/ rotation/ of medical and ALLIED HEALTH PROFESSIONAL

Yes

b. STANDARD PERTAINING TO PERSONAL RECORD KEEPING AND TRAINING

c. PAYMENT/ROSTER OF STAFF

Yes

d. OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff in lab,bld bank,TLD badges

Yes Yes

M D

3 Equipment

Therapeutic Surgical Diagnostic Emergency

Yes

HAMMER, SPLINTS, KRAMMER WIRE,THOMAS SPLINT, PELVIC BINDER,SKIN TRACTION,CERVICAL COLLAR,SPINE BOARD

Yes

HAMMER,SPLINTS,KRAMMER WIRE, THOMAS SPLINT, PELVIC BINDER,SKIN TRACTION,CERVICAL COLLAR,SPINE BOARD

Also Refer documents on Hospital

Sterlizing

Yes

Drugs,Medical devices and Yes consumables

Yes Also Refer documents on

List of disposables Yes Annual Maintenance records of Yes equip

Hospital Yes M

4 Support Services

4.1. Laboratory Yes

Yes own or Outsourced

4.2. Imaging Yes

Yes Own/out sourced / Tie up

4.3. Pharmacy Yes

4.4. sterlization/CSSD Yes

4.5. Laundry/Kitchen Yes

4.6. Medical Gas/Manifold Yes

4.7. Bloodstorageunit/blood Yes

Bank outsourced / TIE UP

4.8. Amb service Yes

Yes M-own/ outsourced / TIE UP

M-Mandatory D- Desirable

Yes D

Yes M-IN ADVANCE Yes M

Yes own or Outsourced Yes M-IN ADVANCE Yes M-own/

1 Definition

2 Scope

Specialist

Minimum standards for Clinics/ Polyclinics

Minimum Standards

Remarks

Services Provided

CONSULTATION SERVICES, PLASTER APPLICATION AND REMOVAL, SUTURING AND DRESSING,SPLINT APPLICATION; local injection allowed but no intra- articular without asepticOT

3 Physical Infrastructure a. Space requirement

Room for consultation,minor OT,room for plaster application and removal

i. Reception

ii. consultation/waiting area iii. OPD Area

Yes Yes Yes

M M M

4 Human resources

Med person incharge

Tech staff

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff in lab,bld bank,TLD badges

MS /DNB/Diploma ORTHOPAEDICS NURSE-1

attendant-1

yes

D M D D

5 Equipment

a. Stethoscope b. Thermometer c. BP Apparatus d. Glucometer

Yes Yes Yes Yes

M(Mercury free) M(Mercury free) M

CLINIC WITH ORTHOPAEDICSERVICES

Yes

e. Weigh machine f. other

Yes M HAMMER,SPLINTS,KRAMMER WIRE,THOMAS M

g. Emergency kit and medicine h. Drugs,Medical devices and consumables

i. List of disposables

SPLINT,PELVIC BINDER,SKIN TRACTION,CERVICAL COLLAR,SPINE BOARD

Yes

Refer document of Clinic/Polyclinic M

j. Annual Maintenance records of

Yes Yes

M D-Desirable

equip

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Yes Yes Yes Yes

M own/outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while examining especially females

b. Infection control practices

Yes

soap and water

facilities for hand washing and disinfection

Disinfection of work Area

Yes Yes Yes

M M M

Use of disposable services

small autoclave

c. Policy on outsourced services

Yes Yes Yes Yes

M M M D

M- Mandatory

D-Desirable

1 Scope

Providing services ( example Primary Health Centre, Community Health Centre, SDH,District Hospital ,Private Hospital,Nursing Home etc)

Providing services (example Civil Hospital, regional Hospital,Nursing Home,Private Hospital of similar scope).

Template for Minimum

BASIC (General Purpose)

ADVANCE

Remarks

Services Provided

OPD ENT dianostics-Audiometry, tympanometry, Emergency ENT procedures, Stridor, Tracheostomy, Foreign Body removal(nasal and aural),nasal packing,incision and drainage of simple neckabscess

OPD ENT dianostics including endoscopy, Emergency ENT procedures, Stridor, Tracheostomy, Foreign Body removal(nasal and aural),nasal packing,incisionanddrainageofhead& neck abscess , bronchoscopy,Nasoendoscopic surgeries.Microscopic,endoscopic and open ENT surgeries,Skull base surgery

1.1.General purpose

1.2.Single Speciality

Yes Yes Yes

Yes Yes

1.3.Multispeciality 2 Human resources

2.1 Doctors

Med person

incharge Fulltimeconsultant Yes or

MS/DNB /DLO/ENT Surgeon-2 Yes or

Yes or

Yes

Part time Yes or consultant

visiting consultant Yes

OTORHINOLARYNGOLOGY SERVICES IN HOSPITAL

MS/DNB /DLO ENT Surgeon-1

M-Mandatory

Duty Doctors

MBBS Doctors

MBBS Doctors for round the clock Medical Cover; part of hospital

2.2 Nurses General nurses Trained Nurses for ICU/OT/HDU

2.3 Pharmacist

1 Yes 1 Yes

Part of Hospital ICU norms

2.4 Para Medical staff

Yes

M-Mandatory in inhouse pharmacy

a.Tech

Audiometry technician/Assistant-1

Audiometry technician/Assistant-1; speech pathologist-1

Yes

M-Mandatory

b.Xray Technician c.OT Technician d.ECG Technician e.Dietician f.Physiotherapist g.Psychologist h.Medicosocial worker

Yes Yes Yes yes yes yes yes

Yes Yes Yes Yes Yes

M-own/outsourced M-own/outsourced D-own/outsourced D-Desirable D-Desirable D-Desirable D-Desirable

3 Equipment

Therapeutic

Tongue depressor,Thudicum nasal

speculum,Aural speculum,Tilleys forcep,Indirect laryngoscopymirrors,Posteriorrhinoscopymirror,

Wax probe,Alligator forceps,Eustachian Tube catheter,Spiritlamp,Suctiontipconnector,Suction probe,Alligatorforceps,EustachianTube

Surgical

Portable Light,Tracheostomy set,Minor set, general set.

Portable Light,Tracheostomy set,Thyroid set,MLS set,general set,minor set,direct larygoscopy set,bronchoscopy set,CWL set,FESS set,Endoscopes with monitor, surgical drill,mastoid set,shea set, myringoplasty set, surgical microscope, tonsillectomy set,microdebrider,CO2 laser machine,nerve monitor machine,vascular set.

M-Mandatory

tips

catheter,Spirit lamp,Suction tip connector,Suction tips

Tongue depressor,Thudicum nasal speculum,Aural speculum,Tilleys forcep,Indirectlaryngoscopy mirrors,Posterior rhinoscopy mirror,Wax

Diagnostic

ENT Tray,portable head light

ENT Tray, portable head, endoscopes, surgical microscope

M-mandatory; ENT Tray-Tongue depressor- 10,Thudiculum nasal speculum-10, Aural speculum- 10(different sizes),Tilley’s forcep, Indirect laryngoscopy mirror- 5, posterior rhinoscopy mirrors- 5,wax probe-2, Alligators forcep-5, Eustachian tube catheter-1, spirit lamp-1, suction tip connector-1, suction tips(different sizes)- 5

Emergency

For epistaxis-Killian’s nasal speculum,Tilley’s forcep,Tongue depressor,Bowl,Nasal packs- anterior/posterior.Emergency Set

For epistaxis-Killian’s nasal speculum,Tilley’s forcep,Tongue depressor,Bowl,Nasal packs- anterior/posterior.Emergency set- 1;Tracheostomy set-1;general set- 1;surgical microscope-1.

Emergency Kit- Killians Nasal speculum-1,Tilley’s Forcep-1,Tongue depressor-1,Bowl- 1,Nasal packs-

Sterlizing Drugs,Medical devices and consumables

List of disposables Annual

autoclave/boiler-1 Life saving drugs

autoclave

Life saving drugs

M-Mandatory Refer to Hospital documents

4 Support Services

4.1. Laboratory 4.2. Imaging 4.3. Pharmacy

Yes Yes

M-if own lab M-if own

M-IN ADVANCE

gloves,sterile gauze,cotton,gown yes

M D-Desirable

4.4. Yes Yes sterlization/ CSSD

4.5. Medical Yes Yes Gas/Manifold

4.6. Blood storage Yes Yes unit/blood Bank

4.7. Amb service Yes Yes

M-own/ outsourced/ TIE UP

M-own/outsourced

1 Definition

2 Scope

Specialist

Services Provided

OPD Diagnostics, syringing, wax, epistaxis management, laryngoscopy andsimple nasal and ear foreign body removal

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area iii. OPD Area

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

4 Human resources

Med person incharge

Tech staff

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS

MS/DNB/DLO ENT Nurse-1 Attendant-1

Yes

optional

M D-Desirable D

5 Equipment

Stethoscope Thermometer BP Apparatus Glucometer Weigh machine

Yes

Yes Speculum,ENTTray,Portablelight,suctionmachine-1

Yes (Non Mercury) Yes (Non Mercury) M

CLINIC WITH OTORHINOLARYNGOLOGY SERVICES

Template for Minimum standards for Clinics/ Polyclinics

Minimum Standards

Remarks

yes

M-mandatory; ENT Tray-Tongue depressor- 10,Thudiculum nasal speculum- 10 , Aural speculum- 10(different sizes),Tilley’s forcep, Indirect laryngoscopy mirror-5,posterior rhinoscopy

Emergency kit and medicine

EmergencyKit;medicinesalineandxylometazolidine nasal drops, antibiotic and anti -fungal ear drops,betadine gargle, antihistamine, 10% xylocaine spray,betadine solution. For epistaxis-Killian’s nasal speculum,Tilley’s forcep,Tongue depressor, Bowl, Nasal packs-anterior/posterior

Emergency Kit- Killians Nasal speculum-1, Tilley’s Forcep- 1,Tongue depressor-1, Bowl- 1,Nasal packs- anterior-2,

Drugs,Medical devices and consumables List of disposables

Annual Maintenance records of equip

sterile gauze pieces, gloves, dressing,adhesive Yes

Yes

M D-Desirable

6 support services

a.sterlization/CSSD b. security

c. BMW management d. Laundry

Table top/boiler-1 Yes

Yes

M own/outsourced

7 Standard on basic processes a.Receivingpatients,privacyforpatientswhileexaminingespeciallyfemales

Yes

M-Mandatory

b. Infection control practices

Yes Yes Yes Yes Yes Yes Yes

M M M M M M D

soap and water

facilities for hand washing and disinfection Disinfection of work Area

Use of disposable services

small autoclave

c. Policy on outsourced services

TemplateforMinimumstandardsforClinics/Polyclinics

Minimum Standards

Remarks

1 Definition

2 Scope

General/ Specialist

Services Provided

Clinical ENT evaluation, audiometry, (Optional Speech therapy)

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

M-mandatory M-mandatory

4 Human resources

Doctors Tech staff

MS /DNB/DLO ENT provide cover AUDIOLOGIST/Speech Pathologist-1( BSc Audiology)

M D

Non Tech staff

Attendant-1 Yes

Yes

Duty and salary roster

D D

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff in lab,bld bank,TLD badges

5 Equipment

Stethoscope Thermometer BP Apparatus

Yes Yes Yes

M-mandatory

M-mandatory; ENT Tray-Tongue

DEAF AND DUMBCLINIC

Speculum,ENT Tray,Portable light-1,suction machine- 1,audiometry machine-1, Tympanometry machine-1(Optional)

depressor-10,Thudiculumnasal speculum-10,Aural speculum- 10(different sizes),Tilley’s forcep,Indirectlaryngoscopymirror- 5,posterior rhinoscopy mirrors- 5,wax probe-2,Alligators forcep- 5,Eustachian tube catheter-1,spirit lamp-1,suction tip connector- 1,suction tips(differentsizes)-5

Emergency kit and medicine

)Emergency Kit ; medicine saline and xylometazolidine nasal drops,antibioticandanti-fungaleardrops,betadinegargle, antihistamine, 10% xylocaine spray,betadine solution.

Emergency Kit-Killians Nasal speculum-1,Tilley’s Forcep- 1,Tongue depressor-1,Bowl-1,Nasal packs-anterior-2,posterior-2

List of Disposables

sterile gauze pieces, gloves, dressing, adhesive Yes

M D

Annual maint of equipt

6 support services

sterlization/CSSD security

BMW management Laundry

Table top boiler/Autoclave-1 Yes

Yes

M own/outsourced

7 Standard on basic processes

a.Receiving patients,privacy for patients while examining

Yes

M-mandatory

especially females b.Infection control practices

Yes Yes Yes Yes Yes Yes Yes Yes

M-mandatory M

soap and water

facilities for hand washing and disinfection Disinfection of work Area

Use of disposable services small autoclave

facilities for sterlization

c.Policy on outsourced services

M D-Desirable

Template for Minimum standards for Hospital under CEA

MINIMUM STANDARDS

Remarks

1 Scope

Services Provided 1.1.General purpose 1.2.Single Speciality 1.3.Multispeciality

Yes Yes Yes

2 Human resources

2.1 Doctors

Med person incharge

Other Doctors dedicated for psychiatry

Duty Doctors, as per case load of the hospital 2.2 Nurses

MD/DNB in PSYCHIATRY/DPM MBBS-1

MBBS for round the clock service

M (May be part of the hospital)

Nursing head

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

2.4 Para Medical staff

a.Lab Tech

b.Xray Technician

c.ECG Technician

d.Dietician

e.Physiotherapist

f.Psychologist

g.Medicosocial worker

2.5 Support Staff

a. Receptionist & Billing Staff

b. MRD Office Staff

1 Yes

as per nursing council norms D

PSYCHIATRY SERVICES INHOSPITAL

Yes Yes

M- part of the hospital M- part of the hospital

1 1 1

M-if own

M-if own M-own/outsourced D

1 1

D- own/ Outsourced D- own/ Outsourced

M- own/outsourced

c. Security closed circuit surveillance and sanitation

Yes

M- Sanitation and security D-

d. Transport facility including driver e. Data entry operators

f. Housekeeping

2.6 Rapid response team

closed circuit surveillance 1 M- own/outsourced

2.7 Others

a. Policy for Manpower/ posting /rotation/ of medical and Allied Health Professional

b. Standard Pertaining To Personal Record Keeping And Training

c. Payment/Roster OfStaff

d. Other Requirment Like Periodic Health Checkups,Vaccination of staff in lab, blood storage Unit,TLD badges

3 Equipment

3.1Therapeutic

Brief pulse ECT machine; Anaesthesia equipment for MECT; Computerised Biofeedback machine(Desirable)

3.2 Diagnostic 3.3 Emergency

Inj Haloperidol,Inj Promethazine,Inj Diazepam,Inj Lorazepam,Inj Naloxone,IV B Complex,Inj Flumazenil

3.4 Sterlizing

Yes Yes

Part of the hospital M

M M D

3.5 Drugs,Medical devices and consumables

Tab Chlorpromazine, Haloperidol, M Olanzepine, Tab Fluoxitine, Carbemazepine, Phenobarbitone,Tab Tramadol, Propanolol, Antacids, Analgesics

3.6 List of disposables

Yes Yes

M D

3.7 Annual Maintenance records of equipment

4 Support Services

4.1 Reception & Billing 4.2 MRD Services

4.3 Laboratory

4.4 Imaging

Yes Yes Yes yes Yes yes yes Yes Yes Yes

M- part of hospital M- part of hospital own or Outsourced own or Outsourced own or Outsourced D

4.5 Pharmacy

4.6 Sterlization/CSSD 4.7 Laundry/Kitchen

4.8. sterlization/CSSD 4.9.Medical Gas/Manifold 4.10. Ambulance service

own or Outsourced

M-own/outsourced /TIE UP

M-Mandatory

D – Desirable

Minimum standards for Clinics/ Polyclinics

Clinic with Psychiatrist

Psychology clinic

DAY CARE

REMARK

1 Definition

2 Scope

Specialist CONSULTATION SERVICES

Specialist

Services Provided

CONSULTATION SERVICES

CONSULTATION SERVICES, MECT

3 Physical Infrastructure a.Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

4 Human resources

Doctors

MD/DNB IN PSYCHIATRY/DPM

M D/Outsourced

Tech staff

Non Tech staff

Duty and salary roster

ATTENDANT-1 Yes

RCI recognised MPhil in ClinicAnaesthetist on call ATTENDANT-1

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS, Vaccination of staff in lab, blood storage unit, TLD charges

5 Equipment Stethoscope

Yes Yes Yes Yes Yes

Not Required Not Required Not Required

Yes Yes Yes Yes Yes

Yes (Non Mercury) Yes (Non Mercury) D

Thermometer

BP Apparatus Glucometer Weighing machine

Yes

PSYCHIATRY CLINIC

Yes

other equipment

OPHTHALMOSCOPE, INSTRUMENT TRAY FOR NEUROLOGIGAL EXAMINATION

Computerised biofeedback machines (desirable)

Brief pulse ECT and Biofeedback : Mandatory Computerised brief pulse ECTmachine with EEG monitoring, Boyle’s apparatus for MECT, Computerised biofeedback machine- desirable

Emergency kit and medicine

Inj.Haloperidol, Promethazine, Diazepam, Lorazepam, Naloxone ,Thiamine, Flumazenil

Anti psychotic – Chlorpromazine,Haloperidol, Resperidone,Olanzapine,Halo peridol.

Anti depressant- Imipramine,Fluoxitine,Escital opram,

Mood Stabilizers-Sodium Valproate.

Anti epileptic- Phenobarbitone Diphenylhydation. Inj promethazine, triphenidylpropranolol, antacids.

Inj.Haloperidol, M Promethazine,Diazepam, Lorazepam, Naloxone ,Thiamine, Flumazenil

Brief pulse ECT and Biofeedback

Anti psychotic – Chlorpromazine,Haloperid ol,Resperidone,Olanzapin e,Haloperidol.

Anti depressant- Imipramine,Fluoxitine,Esci talopram,

Mood Stabilizers-Sodium Valproate.

Anti epileptic- Phenobarbitone Diphenylhydation. Inj promethazine, triphenidylpropranolol, antacids.

Drugs,Medical devices and consumables

Yes no Yes

M-Refer to documents on Clinic/Polyclinic M

List of disposables

Annual Maintenance records of equip

Yes no Yes Yes no Yes

D-Desirable

6 support services

sterlization/CSSD security

BMW management Laundry

Yes no Yes Yes Yes Yes Yes no Yes Yes Yes Yes

M own/outsourced

7 Standard on basic processes a. Receiving patients,privacy for patients while examining especially females

Yes Yes Yes

b. Infection control practices soap and water

Yes Yes Yes Yes Yes Yes Yes Yes Yes

M M M

facilities for hand washing and disinfection

Disinfection of work Area Use of disposable services small autoclave

Yes no Yes Yes no Yes Yes no Yes Yes Yes Yes

M M D D

c. Policy on outsourced services

M- Mandatory D – Desirable

MinimumstandardsforHospitalunderCEA

MINIMUM STANDARDS

Remarks

1 Definition 2 Scope

Drug Dependence Treatment Centre

Services Provided

1.1.General purpose

Yes Yes

1.2.Single Speciality 3 Human resources

Med person incharge

Duty Doctors

1.2 Nurses

Nursing head

General nurses

Trained Nurses for ICU/OT/HDU 1.4 Para Medical staff

MD/DPM/DNB PSYCHIATRY for 24 HRS COVER MBBS Doctors

M M

Lab Tech

Xray Technician

ECG Technician

Dietitician

Physiotherapist

Psychologist/Medico-social worker /Counsellor

yes yes yes yes Yes 1

M-if own M-if own D

Medicosocial worker

1.5 Support Staff

a.Receptionist & Billing

b.MRDOffice

c.Securityclosed circuit surveillance and sanitation

COUNCELLOR-2

d.Transport facility including driver

Yes

Sanitation and Security; Must Closed circuit surveillance M-own/outsourced

DEADDICTION CENTRE

1 yes 2

M- as required M

Yes Yes Yes

M -Full time/Part time/ Visiting

e.Data entry operators 1.7 others

Yes Yes

M M

Policy Manpower/ posting/ rotation/ of medical and Allied Health Professional

Standard Pertaining To Personal Record Keeping And Training

Yes

PAYMENT/ROSTER OF STAFF

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS

Yes Yes

M D

4 Equipment

Emergency

Sterlizing

Drugs,Medical devices and consumables List of disposables

Annual Maintenance records of equip

Yes Yes Yes Yes Yes

Refer Hospital Document M-if own

Refer Hospital Document M

5 Support SERVICE

Reception &Billing

Laboratory

Imaging

Pharmacy

sterlization/CSSD Laundry/Kitchen

Medical Gas/Manifold

Blood storage unit/blood Bank

Yes Yes Yes Yes Yes Yes Yes

M D-own/outsourced D-own/outsourced D-own/outsourced M-Mandatory M-own/Outsourced M

referral

Amb service

Yes

M- Mandatory

D- Desirable

Minimum standards for Hospital

BASIC (General purpose)

ADVANCE

Remarks

1 Scope

Providing services ( example Primary Health Centre, Community Health Centre, SDH, District Hospital, Private Hospital,Nursing Home etc)

Providing services (example Civil Hospital, regional Hospital,Nursing Home,Private Hospital etc of similar scope)

ServicesProvided

BASICOPHTHALMICCARESERVICES

Surgicalproceduresincludingbutnotlimitedto anythefollowinglikecataractsurgery,todiagnose andtreat-superficialanddeepinjuries,refractive error, glaucoma, injuries, eye problems due to systemic diseases, squint & amblyopia, retinal disease, paediatric ophthalmology, oculoplasty , retinasurgeries,lasers,keratoplasty,refractive lasers and refractive surgeries etc.

Itisnotnecessaryfora hospitaltohaveallthe facilities in-house.A planned referral policy or arrangement for facilities not available should be available

1.1.General purpose 1.2.Single Speciality 1.3.Multispeciality

Yes

2 Human resources Med person incharge

MD/MS Ophthalmology/DO/DNB-1

Upto 20 beds

20-40 EYE BEDS-2 SENIOR MS/DNB /DO OPHTHALMOLOGY

Yes

Yes or

Yes

MBBS DOCTORS FOR ROUND THE CLOCK COVER

M-Mandatory

Full time consultant Part time consultant visiting consultant Duty Doctors

Yes or

Yes

MBBS DOCTORS FOR ROUND THE CLOCK COVER

M-Part of Hospital

OPHTHALMOLOGY SERVICES IN HOSPITAL

Yes Yes

2.2 Nurses

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

2.4 Para Medical staff

a.Tech

b.Xray Technician

c.OT Technician

d.ECG Technician

e.Dietitician

f.Physiotherapist

Yes

yes 2 yes

As per norms of Nursing Council

ICU Norms own/outsource

g. Psychologist

h. Medicosocial worker

Yes

Yes Yes

D-part of Hospital

3 Equipment

Therapeutic

Illuminated Snellen’s vision drum/charts,Near vision chart,Retinoscope,Trial set, Ophthalmoscope & Slit Lamp.

Snellens chart,Trial Set,Colour vision,Near Vision, Ophthlmoscope, and retinoscope,Bright focus torch,slit lamp, tonometer, indirect ophthalmoscope, Gonioscope-Mandatory Optional-Auto Refractor,Non contact Tonometer,Nd YAG laser,Visual Field Analyzer,Fundus camera,instrument for removal of Stye,Chalazion,corneal foreign body removal

Surgical Emergency

M-Mandatory Yes M-Mandatory

Sterlizing

Yes

Optometrist/Ophthalmic technician Yes

Yes

Optometrist/Ophthalmic technician Yes

Yes

Mifown

D-own/outsource D-own/outsource D-own/outsource (ocular exercise)

Yes Yes

ResuscitationEquipmentadult,Ambubag/ Airway/ Oxygen cylinder

Ophthalmology Tray

ResuscitationEquipmentadult,Ambubag/Airway/ Refertodocumenton Oxygen cylinder Hospital

Drugs,Medical devices and consumables

0.5%Tropicamide drops, 0.5% Tropicamide+5% phenylephrine drops, 2% Homatropine drops/ointment, Sterile Fluoresin stick. Ciprofloxacin eye drops 0.3%,ciprofloxacin 0.3% ointment,Sulphacetamide eye 20%Moxifloxacin 0.5%, Tobramyc in 0.3% Anti inflammatory Flubiprofeneyedrops,Predaetateeyedrop1%Anti GlaucomaDrugsTimololeyedrops-5%Pilocarpine eyedrops2%, Tab Acetazolamide 250 mgSyrup Glycerol, Inj mannitol Lubricating eye

Sterile pads,bandage Annual Maintenance records of Yes

Sterile pads,bandage Yes

M-Mandatory D-Desirable

List of disposables

equip

4 Support Services

4.1. Laboratory Yes 4.2. Imaging yes 4.3. Pharmacy Yes 4.4 Medical Gas/Manifold Yes 4.5. Blood storage unit/blood Bank Yes

Yes Yes Yes Yes Yes

own or Outsourced own or Outsourced M-Mandatory M-Mandatory

4.6. Amb service Yes

Yes

D M-own/outsourced/TIE

0.5%Tropicamide drops, 0.5%

Tropicamide+5%phenylephrinedrops,2%

Homatropine drops/ointment, Sterile

Fluoresin stick. Ciprofloxacin eye

drops.3%,ciprofloxacin 0.3%

ointment,Sulphacetamide eye

20%Moxifloxacin0.5%,Tobramycin0.3%Anti

inflammatory Flubiprofen eye

drops,Predaetate eye drop1% Anti Glaucoma

Drugs Timolol eye drops-5% Pilocarpine

eyedrops2%,TabAcetazolamide250mgSyrup drops:preservativefreeHPmcorSodiumCMC0.3- Glycerol,Injmannitol Lubricating eye 05%

M-Mandatory

drops:preservative free HPmcor Sodium CMC 0.3-05%

M-Mandatory D- Desirable

Minimum standards for Clinics/Polyclinics

NON SURGICAL CLINICS

SURGICAL CLINICS

Remark

1 Definition

2 Scope

Specialist

Services Provided

CONSULTATION, REFRACTIVE ERROR, DETECTION OF CATARACT, SQUINT, CORNEAL ULCER, GLUCOMA(basicOpthalmicdisorder/IOP Measurement)

REFRACTION- MANUAL/ AUTOREFRACTOR, SYRINGING, FB REMOVAL, EPILATION, SUTURE REMOVAL SUBCONJUNCTIVALS INJECTIONS, WART & STYE EXCISION, CORNEAL SCRAPING, I&D OF LID ABSCESS IOP Measurement: AT (Applantaion Tonometry) / NCT (Non-contact tonometry)

3 Physical Infrastructure b. Space requirement i. Reception

Yes

ii. consultation/waiting area

Yes Yes

M M

iii. OPD Area

4 Human resources

Med person incharge Tech staff

Non Tech staff

Duty and salary roster OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff

MS/DNB/DIPLOMA OPHTHALMOLOGY NURSE-1

Attendant-1

Yes

MS/DNB/DIPLOMA OPHTHALMOLOGY OT TECH-1-M

Attendant-1

Yes

5 Equipment

a. Stethoscope

b. Thermometer c. BP Apparatus d. Glucometer

e. Weigh machine

Yes Yes Yes Yes Yes

Yes (Non Mercury) Yes (Non Mercury) M

Yes

M M D

CLINIC WITH OPHTHALMOLOGY SERVICES

f. Others

AT (Applantaion Tonometry) / NCT (Non-contact tonometry)

ILLUMINATED SNELLENS VISION M DRUM/CHARTS,RETINOSCOPE,TRIAL

SETprism bar maddox rod synatophore(d)

red green glasses.wf dot test

g. Emergency kit and medicine

Tab. Acetazolamide,Xylocain 2%, Paracaine 4%

.5%TROPICAMIDE, .5%TROPICAMIDE+5%PHENYLEPHRINE, 2%HOMATROPINE, STERILE FLUORESIN

STICK, .3%CIPROFLOXACIN DROP

yes M

h. Drugs,Medical devices and

yes

consumables

6 support services

sterlization/CSSD security

BMW management Laundry

yes Yes Yes Yes

yes M

Yes D

Yes M

Yes Own/outsourced

7 Standardonbasicprocesses a. Receiving patients,privacy for patients while examining especially females

Yes

Yes D

b. Infection control practices

Yes Yes

Yes M Yes M

soap and water

facilities for hand washing and disinfection Disinfection of work Area

Yes Yes Yes Yes Yes

Yes M Yes M Yes M Yes M Yes M

Use of disposable services small autoclave

facilities for sterlization

c. Policy on outsourced services

Yes

Yes D

M- Mandatory

D- Desirable

Minimum standards for Clinics/Polyclinics

Minimum standards

REMARKS

1 Scope

Services Provided

REFRACTIVE ERROR,DETECTION OF CATARACT,SQUINT,CORNEAL ULCER

2 Physical Infrastructure

b. Space requirement

i. Reception

ii. consultation/waiting area iii. OPD Area

10’*15′,DARK ROOM

3 Human resources

Doctors

Tech staff

Non Tech staff

Duty and salary roster

ophthalmologist BSC OPTOMETRICS Attendant

Yes

M-Mandatory D-Desirable M

4 Equipment

other

STREAK RETINOSCOPE,VISION CHART,NEAR VISION, AUTO REFRACTOR,AUTO KERATOFACTOR (OPTIONAL) .5%TROPICAMIDE,.5%TROPICAMIDE+5%PHENYLEPH RINE,2%HOMATROPINE, STERILE FLUORESIN STICK, .3%CIPROFLOXACIN DROP

Emergency kit and medicine

M-Mandatory

Annual Maintenance records of equip

Yes

5 support services

a security

b. BMW management c. Laundry

Yes Yes Yes

M own/outsourced

OPTOMETRIST SERVICES

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

6 Standard on basic processes a.Receivingpatients,privacyforpatientswhile examining especially females

b. Infection control practices

Yes

soap and water

facilities for hand washing and disinfection Disinfection of work Area

Yes

yes

Yes

M- Mandatory

M M M M M D M D

Use of disposable services

small autoclave

facilities for sterlization

c. Policy on outsourced services

D- Desirable

Minimum standards for Hospital

BASIC (General Purpose)

ADVANCED

Remarks

1 Scope

Providing services (examplePrimaryHealthCentre, Community Health Centre, SDH, District Hospital, Private Hospital,Nursing Homeetc)

Providing services (example Civil Hospital, regional Hospital, Nursing Home,Private Hospital etc of similar scope)

Services Provided

OPEN SURGERY,OTHER SURGERIES EXCLUDING ADVANCED RECONSTRUCTIVE SURGERIES LIKE RADICAL PROSTECTOMIES, AND ONCOLOGY SURGERIES.SIMPLE LAPROSCOPIC SURGERIES E.G., NEPHRECTOMY, URETERLITHOTOMY, NO ENDOSCOPIC SURGERIES ALLOWED.

OPEN SURGERIES, ENDO UROLOGY, LAPROSCOPIC UROLOGICAL PROCEDURES , ESWL, URODYNAMICS FACILITIES (PREFERRED) RECONSTRUCTIVE SURGERY

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

Yes

2 Human resources Med person incharge Full time consultant Part time consultant visiting consultant Duty Doctors

MS GENERAL SURG/MCh /DNB UROLOGY Yes or

Yes or

M.Ch /DNB UROLOGY-1

also GENERAL SURGEON-2

Yes or

MBBS doctor for round the Clock medical cover

M M M M M

2.2 Nurses

General nurses

Trained Nurses forICU/OT 2.3 Pharmacist

MBBS Doctor for round the Clock medical cover 2

Yes

Yes 2 yes

As per ICU morms M-for inhouse pharmacy

UROLOGY

Yes Yes Yes

2.4 Para Medical staff a.Lab Tech

b.Xray Technician c.OT Technician d.ECG Technician e.Dietitician

Yes Yes 1/OT Yes Yes Yes Yes Yes

M-if own

M-if own M-Mandatory D-own/outsource on call

f. Physiotherapist

g. Psychologist

h. Medicosocial worker

3 Equipment

Therapeutic

LAPROSCOPY SET, OPEN SURGERY EQUIPMENT

LAPROSCOPY SET, OPEN SURGERIES INSTRUMENT, UPPER AND LOWER TRACT ENDOSCOPY , emergency electrocauery, laser /pneumatic lithtripter(D) laproscopy.open sugery set for Gynae, gen surg and urology -Mandatory

M -lithotripsy stand alone not permitted

Emergency Sterlizing

yes yes Yes

yes yes yes

Refer to hospital document M-MANDATORY

Refer to hospital document

Drugs,Medical devices and consumables

List of disposables Annual Maintenance records of equip

Yes Yes

M D

4 Support Services

4.1. Laboratory

4.2. Imaging

4.3. Pharmacy

4.4. sterlization/CSSD 4.5. Medical Gas/Manifold

Yes Yes Yes Yes Yes

Yes

M-own/outsourced M-own/outsourced M-IN ADVANCE M

4.6. Blood storage unit/blood Bank 4.7. Amb service

Yes Yes

Yes Yes Yes

M-own /outsourced / TIE UP M-own/outsourced / TIE UP

1 Definition

2 Scope

Specialist

Minimum standards for Clinics/ Polyclinics

CONSULTATION SERVICES

DAY CARE PROCEDURE

REMARK

Services Provided

CONSULTATION SERVICES, DRESSING, FOLEY’s CATHETERISATION, FOLEY’S REMOVAL, USG GUIDED PROCEDURE:PCN, PROSTATE BIOPSY, UROFLOWMETRY, URO DYNAMICS (OPTIONAL)

PROCEDURES UNDER LA , SUPRAPUBIC CATHETERIZATION, PCN, URETHRAL DILATATION, MEATOPLASTY, LOWER TRACT ENDOSCOPY TEST

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area iii. OPD Area

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory;

Minor OT mandatory in Day care

4 Human resources

Doctors

Tech staff

Non Tech staff

Duty and salary roster OTHERREQUIREMENTLIKEPERIODIC HEALTH CHECK UPS,vaccination of staff in lab,bld bank,TLD badges

MS GENERAL SURGEON NURSE-1

Attendant-1

Yes

M.Ch UROLOGY

OT TECHNICIAN-1/ NURSE-1 Attendant-1

Yes

M M-Mandatory M-Mandatory D

5 Equipment

Yes

CLINIC WITH UROLOGY SERVICES

MINOR OPEN PROCEDURES ORCHIDECTOMY, MEATOPLASTY, TESTICULAR BIOPSY

a. Stethoscope

b. Thermometer

c. BP Apparatus

d. Glucometer

e. Weigh machine

f. Emergency kit and medicine

Yes

DRESSING TRAY, CATHETERISATION TRAY, PORTABLE LIGHT

Yes

ENDOSCOPY FOR LOWER TRACT ONLY(OPTIONAL) OPENSURGERY SET

Also refer to Clinic/ Polyclinic document

g. Drugs,Medical devices and consumables

h. List of disposables

i. Annual Maintenance records of equip

Yes

6 support services

sterlization/CSSD security

BMW management Laundry

Autoclave Yes

Yes

Autoclave Yes

Yes

M own/outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while examining especially females

b. Infection control practices

Yes

soap and water

facilities for hand washing and disinfection

Disinfection of work Area

Yes Yes Yes

M M M

Use of disposable services

small autoclave

facilities for sterlization

c. Policy on outsourced services

Yes Yes Yes Yes Yes

M M M M D

Yes Yes

M D

Minimum standards for Hospital

BASIC (General Purpose) ADVANCE(Non Teaching Hospital)

Remarks

1 Scope

Providingservices(examplePrimaryHealth Providingservices(exampleCivilHospital,

Services Provided

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

Yes

2 Human resources 2.1. Doctor

Med person incharge Full time consultant

MD/DNB NEPHROLOGY

MD/DNB NEPHROLOGY MD -1

Duty Doctors 2.2 Nurses

cover

part of hospital

As per norms of Nursing Council

As per paramedics council norms

Nursing head

Dialysis Nurse/Technical

Yes Yes

NEPHROLOGY SERVICES INHOSPITAL

Centre, Community Health Centre, SDH, District Hospital, Private Hospital,Nursing Home etc)

regional Hospital,Nursing Home,Private Hospital etc of similar scope)

KIDNEYBIOPSY,MINOROT,CENTRALVEIN ALLBASICSERVICES,CAPD,

,CATHETERISATION, ACUTE PERITONEAL DIALYSIS

CATHETERISATION, AV FISTULA, PERMA CATH, RENAL TRANSPLANT

MD WITH EXPERIENCE IN NEPHROLOGY from a recognised hospital

MBBS Doctors for round the clock medical cover

M MBBS Doctors for round the clock medical

Yes Yes Yes

General nurses

Trained Nurses for ICU/OT 2.3 Pharmacist

2.4 Para Medical staff a. Lab Tech

b. Xray Technician

c. OT Technician

Yes Yes Yes Yes Yes Yes

As per norms of Nursing Council

ICU norms

M-inhouse pharmacy

d. ECG Technician e. Dietitician

f. Physiotherapist g. Psychologist

DIALYSIS MACHINE (MAN POWER AS PER GUIDELINES-NURSE-1,TECHNICIAN-1) Yes Yes Yes Yes Yes* Yes Yes Yes Yes Yes Yes

M-own/outsourced *M

M IF PSYCHIATRIST D

h. Medicosocial worker

3 Equipment

Therapeutic

DIALYSISMACHINE(MANPOWERASPER DIALYSISMACHINE(MANPOWERASPER GUIDELINES- minimum NURSE-1, GUIDELINES-minimum NURSE-1, TECHNICIAN-1) TECHNICIAN-1)

Yes Yes

M;Refer Dialysis Centre

Diagnostic

Emergency

Sterlizing Drugs,Medical devices and consumables

Yes Yes Yes Yes

Refer to documents of Hospital M

List of disposables Annual Maintenance records of equip

Yes Yes Yes yes Yes Yes

Refer to documents of Hospital M

4 Support Services

4.1. Laboratory

Yes Yes

Basic Laboratory facilities must be available in the hospital and advance can be Outsourced

Yes Yes Yes Yes

M-if own

M (Refer Dialysis Centre)

4.2. Imaging

Basic Imaging facilities must be available in the hospital and advance can be Outsourced

4.3. Pharmacy Yes Yes 4.4. sterlization/CSSD Yes Yes 4.5. Medical Yes Yes Gas/Manifold

M-IN ADVANCE M

M-IN ADVANCE

4.6. Blood storage Yes Yes unit/blood Bank

4.7. Amb service Yes Yes

M for advance set-up, otherwise D M-own/outsourced/TIE UP

M-Mandatory D- Desirable

Minimum standards for Clinics/Polyclinics

Minimum Standards

Remarks

1 Definition

Nephrology services

2 Scope

Services Provided

1. CONSULTATION (M)

2. ACCESS TO DIALYSIS(D) 3. LAB SERVICES (O)

infrastructure and Staff according to scope of services

3 Physical Infrastructure a. Space requirement i. Reception

ii. Consultation

Yes Yes Yes

M M M

iii. waiting area

4 Human resources

Med person incharge

Technical staff

Non Technical staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff

DM/DNB NEPHROLOGY Yes

Attendant-1

Yes

M M M M D

5 Equipment

a. Stethoscope

b. Thermometer

c. BP Apparatus

d. Glucometer

e. Weigh machine

f. Emergency kit and medicine

g. Drugs,Medical devices and consumables

Yes Yes Yes Yes Yes Yes Yes

Yes (Non Mercury)

Yes (Aneroid)

Refer documents on clinic /polyclinic M

NEPHROLOGY CLINIC

yes

h. List of disposables Yes i. Annual Maintenance records of equip Yes j. O2 cylinder for emergency Yes

M D D

6 support services

a. sterlization/CSSD Yes b. security Yes c. BMW management Yes d. Laundry Yes

Own/ outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while Yes examining especially females

b. Infection control practices Yes

soap and water Yes facilities for hand washing and disinfection Yes Disinfection of work Area Yes

M M M M M M D D

Use of disposable services Yes small autoclave Yes facilities for sterlization Yes c. Policy on outsourced services Yes

M-Mandatory D- Desirable O- Optional

Minimum standards for Clinics/Polyclinics

Minimum Standards

Remarks

1 Definition

2 Scope

Dialysis services

Services Provided

CONSULTATION SERVICES,DIALYSIS

3 Physical Infrastructure Space requirement

i. Reception

ii. consultation/waiting area iii.OPD Area

10*10 SQ FT Yes

Yes

(for 1 machine) M

4 Human resources

Doctors

DM/DNB NEPHROLOGY/MD MEDICINE TRAINED IN DIALYSIS 6 MTHS

Techician-1 Nurse-1

Attendant-1

Tech staff

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff in lab

Yes Yes

M M M D

5 Equipment

Stethoscope Thermometer BP Apparatus Glucometer Weigh machine

Yes

4 DIALYSIS MACHINE (MAN POWER AS PER GUIDELINES- NURSE-1,TECHNICIAN-1); (MINIMUM 2 MACHINES in any Dialysis Centre)

Yes (Non Mercury) Yes (Non Mercury) M

DIALYSIS CENTRE

Emergency kit and medicine Yes Drugs,Medical devices and consumables Yes List of disposables Yes Annual Maintenance records of equip Yes

Refer to Hospital Document Refer to Hospital Document M

6 support services

sterlization/CSSD Yes security Yes BMW management Yes Laundry Yes

M own/outsourced

9 Standard on basic processes

a. Receiving patients,privacy for patients while Yes examining especially females

b. Infection control practices Yes

M-Mandatory

soap and water Yes facilities for hand washing and disinfection Yes Disinfection of work Area Yes

M M M M M M M D

Use of disposable services Yes small autoclave Yes facilities for sterlization Yes c. Policy on outsourced services Yes

M-Mandatory D- Desirable

Minimum standards for Hospital

Single Superspeciality

Multi Superspeciality

Remarks

1 Scope

Providing CTVS services (example Civil Hospital, regional Hospital,Nursing Home,Private

Providing services (example District Hospital, regional Hospital,Nursing Home,Private Hospital,etc

Services Provided

Services relating to cardiothoracic and vascular speciality

Services relating to cardiothoracic and vascular specialities in Multispeciality set up

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

Yes yes

yes Yes

2 Human resources 2.1 Doctors

Med person incharge Full time consultant Duty Doctors

MCh/DNB-1per OT

Gen Surgeon/MBBS-1 MBBSDoctorsforroundtheclock service

MCh/DNB-1per OT M Gen Surgeon -1 , MBBS-1 M MBBSDoctorsforroundtheclockservice M

2.2 Nurses

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

2.4 Para Medical staff

a.Lab Tech

b.Xray Technician

c.OT Technician

d. ECG Technician

e.Dietitician

f.Physiotherapist

g.Psychologist

yes yes M-Mandatory 2 2 ICU Norms

h.Medicosocial worker

psychiatrist Yes Yes D

CTVS IN HOSPITAL

Perfusionist-1 M Yes Yes M Yes Yes M Yes Yes M Yes Yes M

Yes Yes D-Desirable Yes Yes D-Desirable Yes Yes compulsory if

3 Equipment

Therapeutic

OpenHeartTray,GaspipelinesLung Machine with TCM,3 invasive pressure monitor at Anaesthesia work station,suction, defibrillator, ABGMachine,ACTMachine,Single chambered pacemaker, Hypothermiamachine,IABP,temp monitoring module, cautery

Open Heart Tray, Gas pipelines Heart Lung Machine with TCM,3 invasive pressure monitor at Anaesthsia work station, suction, defibrillator,ABG Machine, ACT Machine, Single chambered pacemaker, Hypothermia machine ,IABP, temp monitoring module, Cautery

M-Mandatory

Surgical Diagnostic

2 sets of operating equipment Yes

M-Mandatory M-Mandatory

Emergency

Sterlizing

Drugs,Medical devices and consumables

Yes

Inotropes, protamines, heparin, isopronaline,antiarrhythmic,life saving drugs

yes

Inotropes, protamines, heparin, isopronaline, anti arrhythmic, life saving drugs ,anaesthetic drug.

Refer to document on Hospital

M-Mandatory Alsorefertodocuments on hospital

List of disposables

Yes Yes

M M

Annual Maintenance records of equip

4 Support Services

4.1. Laboratory

Yes

own or Outsourced

4.2. Imaging

yes

Yes

own or Outsourced

4.3. Pharmacy

Yes

M-own/outsourced

4.4. Medical Gas/Manifold

4.5. Blood storage unit/blood Bank

Yes Yes

M-IN ADVANCE M-own/outsourced/TIE UP M-own/outsourced/TIE UP

4.6. Amb service

CCU AMB

Minimum standards for Clinics/ Polyclinics

Minimum Standards

Remarks

1 Definition

2 Scope

Specialist

Services Provided

Consultation Services

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

M-Mandatory M-Mandatory

4 Human resources

Med person incharge

Tech staff

Non Tech staff

Duty and salary roster OTHERREQUIREMENTLIKEPERIODICHEALTHCHECK UPS,vaccination of staff

M.Ch./DNB CTVS ECG Tech

Yes

M M M M D

5 Equipment

a. Stethoscope

b. Thermometer c. BP Apparatus d. Glucometer

e. Weigh machine f. Others

Yes

ECG Machine clopid,Aspirin

Yes (Non Mercury)

Refer to document on clinic/Polyclinic

g. Emergency kit and medicine

h. Drugs,Medical devices and consumables i. List of disposables

j. Annual Maintenance records of equip

Yes Yes Yes

6 support services

a. security

Yes

CLINIC with CTVS SERVICES

Yes

b. BMW management Yes

M D-own/outsourced

c. Laundry Yes 7 Standard on basic processes

a. Receiving patients,privacy for patients while Yes examining especially females

b. Infection control practices Yes soap and water Yes facilities for hand washing and disinfection Yes Disinfection of work Area Yes Use of disposable services Yes small autoclave Yes facilities for sterlization Yes c. Policy on outsourced services Yes

M-Mandatory

D-if applicable D-if applicable D

Minimum standards for Hospital

Minimum Standards

Remarks

1 Scope

Services Provided 1.1.Single Speciality 1.2.Multispeciality

Treatment of Cancer patients by Radiotherapy Yes

Yes

2 Physical Infrastructure a.Location

No Department should be below Radiotherapy Department in a building. Basement or Ground floor is a good option.

b.Space requirement

Space requirement varies from one machine to another, & one manufacturer to other. Any Radiotherapy equipment shall be located in the hospital at a place where occupancy is minimum. Should permit easy installation, source loading,commissioning, patient treatment, maintenance & decommissioning. Approximately 2500 sq. feet

As per AERB

3 Human resources 3.1 Doctor

Med person incharge Full time consultant Part time consultant 3.2 Nurses Generalnurses

RADIOTHERAPIST-1/500 NEW CASES Annually 1

RESIDENT-2

M -Mandatory M-Mandatory M-Mandatory

Trained Nurses for ICU/OT/HDU 3.3 Pharmacist

2 for minor OT/Brachytherapy Yes

ICU norms M-Mandatory,part of Hospital

RADIOTHERAPY SERVICES

OneOncologyNursefor300patientsannually,additionalonefor every 300 more number of patients. Besides, more number needed for Brachytherapy, Simulator and Day Care Chemotherapy.

M-Mandatory

3.4 Para Medical staff Lab Tech

MSCMEDICALPHYSICIST-1RSOEXAMCERTIFIEDORMSCGEN PHYSICISTWITHPGDiPlomaRADIOLOGICALPROTECTION(DRP)

M-Mandatory

Xray Technician ECG Technician Dietitician Physiotherapist Psychologist Medicosocial worker 3.5 others

RADIOTHERAPY TECHNICIAN Yes

Yes

M-Mandatory

D- part of hospital M- part of hospital D-Desirable D-Desirable M-Mandatory

a. PolicyManpower/ posting/ rotation/ of medical and ALLIED HEALTH PROFESSIONAL

b. STANDARD PERTAINING TO PERSONAL RECORD KEEPING AND TRAINING

Yes

M-Mandatory

c. PAYMENT/ROSTER OF STAFF

Yes

For any radiation generating equipment,type/approval/ NOC is must by AERB.Approval of room layout plan of Radiotherapy installation is must before any start of construction and any modification thereof.Procurement of personal monitors and measuring and monitoring instruments as per AERB guidelines is must.These include personal monitors and measuring and monitoring badges,Pocket dosimeter,Ionisation chambers, Electrometer, Radiation field analyser,Survey meter, Gamma zone monitor, suitable air conditioning, and fire fighting measures

M-Mandatory D-Desirable

d. OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff in lab,bld bank,TLD badges

Yes Yes

Yes

M-Mandatory

4 Equipment

Therapeutic

Onelowenergylinearaccelerator/Cobaltteletherapymachine, M-Mandatory One simulator,one TPS (if not part of machine),One HDR BRACHYTHERAPY , immobilization devices,Medical phycists lab

investgation for calibration,Dosimetry and radiationprotection.

Diagnostic Emergency

Yes Yes

M -Mandatory

Refer to documents on Hospital

M-Mandatory Alsorefertodocumentson Hospital

Sterlizing

Drugs,Medical devices and consumables

Yes

Cisplatin, Carboplatin, 5FU, Doxorubicin, cyclophosphamide, Methotrexate,Vincristine, Vinblastine, Bleomycin , Paclitaxel,Gemcitabine, Folinic acid/Leukovorin, Ondansetron, Tab Temazolamide

List of disposables

Yes Yes

M-Mandatory D-Desirable

Annual Maintenance records of equip

5 Support Services

5.1 Laboratory

5.2 Imaging

5.3 Pharmacy

5.4 Medical Gas/Manifold

5.5 Blood storage unit/blood Bank 5.6 Amb service

Yes Yes Yes Yes Yes Yes

own or Outsourced

M part of hospital M-own/outsourced/TIE UP M-own/outsourced/TIE UP

Template I Definition

Basic Composite *

Medium

Advanced

Remarks

II Scope of Services

upto 30 samples

These test can be performed in mobile lab at field centres also

30-100 samples

Apart from the test performed in Basic Composite lab additional tests mentioned as under.

>100 samples

Apart from the test performed in Medium lab additional tests mentioned as under.

a) Biochemistry

Routine Biochemistry Test like Blood Sugar,KFT,LFT,Amylase,lipase,lipid profile, CSF & other biological fluid (glucose and protein), OGTT, Electrolytes, Ca/PO4, HbA1c.Any dry chemistry based rapid test.

a) Routine Biochemistry, b)HormoneBioassay,Tumormarkers, plasma protein electrophoresis

a) Routine Biochemistry, b)HormoneBioassay,Tumor

b) Hematology

Haemogram,BT,CT,PT, APTT, Blood grouping

Haemogram,BT,CT, PT, APTT,Blood grouping, Coagulation Assay

All other Haematology test also

c) Histopathology

d) Molecular Genetics

e) Cytopathogy

NIL NIL NIL

May/ May not do

PAP smear , FNAC , sputum & CSF cytology

Histopathology Examination

f) Immunohistopathology

NIL

Immunohistopathology

as per scope of lab

g) Medical Microbiology & Immunology

Basic test like Rapid Test (point of care) tests for infection,Urine routineandmicroscopy,Hanging dropforVcholerae,Stoolforova ,cyst.AllHIVpositiverapidassays need to be confirmed from the next level diagnostic laboratory.

a) Basic Test as in composite lab

b) Serological tests for viruses , bacteria, fungi,parasites c) Culture Sensitivitytests,Bacterial/fungal) d)OtherspecialstainsbesidesGram’s

a) Basic Test as in composite lab

b) Serological tests for viruses , bacteria, fungi, parasites c)CultureSensitivitytests,Bacterial/ fungal/viruses)Genebasedtests (Nucliec acid tests for infections like Real time PCR tests). Histopathlogy of Infectious diseases. and Desirable: Immunocytochemistry

Medical Diagnostic Laboratories

markers, plasma protein electrophoresis, coagulationprofile,Drugmonitoringand toxicology assay, c) Molecular genetics,Inborn errors of metabolism

molecular genetics

PAP smear, FNAC, sputum cytology and other biological fluidcytology,

D; Ultrasound and CT Guided FNAC

III Infrastructure

1. Signage

Basic signage- A signage Yes Yes within or outside the facility

should be made available

containing the following

information.

Yes M

a) Name of the incharge with Yes Yes qualification and registration

number,

Yes M Yes M

b) Broad Services provided Yes Yes i.e.Hematology,Biochemistry,

Clinical Pathology , Histology,

Cytology Molecular Genetics-

Whichever is applicable

c)Timingsofthedifferent Yes Yes consultants

Yes M Yes D

d) Internet facility/ Telephone Yes Yes and mobile number for

appointment

Fee structure: To be displayed Yes Yes separately including type of

investigation and charges i.e.

Special and routine tests.

Yes M

Safety Signage’s (wherever applicable)

Safety Hazard and Caution Yes Yes signs – Biomedical waste

segreted in colored bins and

bags as per Biomedical waste

Yes M

ManagementandHandling Rules 1998 including Radioactive materials, toxic chemicals, Microbial agents, Infected biologicalmaterial.

AppropriateFireexitsignage’s Yes* Yes* Yes** – Minimum one fire

extinguisher

As per norms*- Desirable **Mandatory

2. Space requirement-

A. Registration and waiting Yes* Yes** Yes** room, Public Utilities, Safe

drinking water etc.

B. Sample collection area Yes Yes Yes C. Laboratory with adequate Yes Yes Yes diffuse and spot lighting

* D **M

D. Toilet Yes Yes Yes E. Reporting and billing area Yes Yes Yes

M M *M

F. Staff room and doctor’s Desirable Desirable Yes* duty room – Male and female

different where 24 hours

services available

G. Washing room Yes Yes Yes

M M

H. Preservation of the Yes Yes Yes specimens and slides

I. Electrical facilities Yes Yes Yes J. Temperature control for Yes Yes Yes specilized equipments like

M M

flow cytometry and chemiluminescence equipments ELISA test equipment etc.

K. Counselling room for HIV yes yes yes L. FNAC room for all patients yes Yes Yes for samplecollection

if applicable D

M. Dark room for No No Yes Immunofluorescence

N. Frozen Section facilities No Yes Yes

if applicable if applicable

M M

4. Furniture & Fixtures

5. Communication system – Telephone and mobile number for appointment 6. Wash – Basins

Yes Yes

Yes M Yes D

IV Human resource

Designation, minimum qualificationofTechnical Head of Lab / Specialist/ Signatories.

MBBS from a recognised institution(withatleastoneyear experience in laboratory work- Desirable

Incharge can be MD/DNB in Pathology/Biochemistry/Medical Microbiology /Lab Medicine/ Diploma in Clinical Pathology (DCP) with one year post diploma experience / MBBS with PhD in any of the 3 subjects/ Apart from incharge, if any special test of other speciality is done, it is desirable that specialist of that subject need be there on full time/part time or outsourced (Special tests means any other apart from routine basic biochemistry, haematology,or medical microbiology tests as listed in basic composite lab)

Medicine/Biochemistry/Medical Microbiology/ DCP with one year post diploma experience / MBBS with PhD in any of the 3 subjects/ Apart from incharge, if any special test of other speciality is done, it is desirable that specialist of that subject need be there on full time/part time or outsourced (Special tests means any other apart from routine basic biochemistry, haematology, or microbiology tests as listed above)

Number of laboratory technicians with DMLT / MLT/BSc in lab sciences/ MSc in lab sciences/PhD in lab sciences qualification (govt / university)

2 LT

4 LT

Support staff (Lab Assistant / Lab Attendant) Roster of salary of staff Periodic health check up and vaccination of staff

2 M

Yes

Yes M Incharge can be MD/DNB Pathology/Lab M

V Equipment / Instruments/ drugs

List of minimum medical diagnostics lab Equipments with quantity

List of minimum medical diagnostics lab Instruments with quantity

Sterilization such Hot air Yes Yes oven or Autoclave

List of reagents and Yes Yes Consumables required

Yes M Yes M

List of Disposables Yes Yes

Yes M

Policy of Annual Yes Yes Maintenance Contract /

Comprehensive

maintenance contract and

Yes D

records for equipment (Log books)

VI Legal/ Statutory Requirements

Legal/ statutory Yes Yes requirements such as

registration for Biomedical

Waste Management Act

Yes M

with state /UTs pollution control board with registration number and date of expiry Site, Space, Location and environmental requirements to be as per local bye laws

VII Record Maintenance and reporting

Reports of all patients Yes Yes Yes datewise and specialty wise

for ex Histopathology,

Cytology, Hematology and

M-mandatory (All Clinical Establishment to maintain information and statistics as provided)

Laboratory Medicine.

Medicolegal records if Yes Yes Yes applicable (as per law)

Record keeping of technicians Yes Yes Yes working in laboratory

M M

indicating their details of qualification training and others

Availability of reference library Yes Yes Yes including books/periodicals/e-

journals/CDs

Duration of preservation of Yes Yes Yes record (as applicable from

time to time)

VIII Standards on basic processes

Infection Control practices – As Yes Yes Yes per BMW Rules 1998

Safety considerations- use of Yes Yes Yes disposable needles etc

M M

Patient Information and Yes Yes Yes Education

Process of calibration of Yes Yes Yes equipments and reagents

M M M M

Booklet of SOPs of all Yes Yes Yes procedures available

Grievance Registration and Yes Yes Yes Disposal mechanism

Process of calibration of equipments and reagents Booklet of SOPs of all procedures available Grievance Registration and Disposal mechanism QUALITY CONTROL in the form of EQAS/ILC as the case may be

Yes Yes Yes M Yes Yes Yes M Yes Yes Yes M Yes Yes Yes D

policy of PROFICIENCY TESTING of tests performed.

Yes Yes Yes D

M- Mandatory D- Desirable

1 Definition

Definition of X-Ray Clinic

X-RayClinic/Cathlab/DSA/OPGandDental/DEXAScan examination and diagnosis

3 Physical Infrastructure 3a Informative signages

Imaging Centers – X-Ray Clinic / Cathlab / DSA / OPG and Dental / DEXA Scan

Template

Minimum Standards Radiological examination and diagnosis

Remarks

2 Scope of Services

Enlist the investigations which can be carried out by X- Ray machine

Portable/ Mobile Xray,Installed X Ray, Fluoroscopy

The scope should match the scanner specification

Name of the Radiologist with qualification and AERB certification of safety and installation with registration number

Yes

M-Mandatory

Display of model of equipment

Broad Services provided

Timings of the facility

Fee structure of different investigations : To be displayed

Yes Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory M-Mandatory

Safety signage’s (wherever applicable)

Yes

M-Mandatory

3b Safety Hazard and Caution signs Appropriate Fire exit signages

Measures / Devices for radiation protection and monitoring of staff

Yes Yes

M-Mandatory M-Mandatory

4 Space Requirement Reception and waiting area Space for keeping machine Reporting room

Yes Yes Yes Yes Yes

AERB guidelines M-Mandatory M-Mandatory M-Mandatory M-Mandatory

Toilet

includingCathLab,Others Xray-IOPA, OPG,CBCT, Others. Others

Absorptiometry (DEXA)

Dental Mammography,

Dual EnergyXray

Patient preparation area

Electrical facilities

Space for keeping patient monitoring apparatus, Resuscitatory appliances and Anesthesia machine for specialized procedures

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

Furniture & Fixtures

Communication system – Telephone, Fax, internet facility and mobile number for appointment and emergency helpline number of manufacturing company

Yes Yes

D-Desirable

Water and Electricity

Toilet (male and female wherever applicable)

Yes Yes

M-Mandatory M-Mandatory

5 Human Resource

(Full time/Part time/Visiting)

Number of Qualified and registered Radiologists Full time/Parttime/Visiting

MD/DMRD Radiology

Number of qualified and registered Nurses Full time/Parttime/Visiting

Number of Radiography technicians with training status and support staff Full time/Part-time/Visiting

Yes

D-DESIRABLE M-Mandatory

Number of scavenging and support staff

Policy for engagement, posting and rotation of staff Roster of payment and salary of staff

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

Periodic health check-up and vaccination of staff

M-Mandatory

1.RSO-degree recognised by MCI/NBE 2.Radiographers passed from recognised institution

6 Equipment/instruments/drugs

Yes

List of equipments required and tools for radiation safety

List of small instruments required

As per scope of service

List of consumables and disposables

BP app, Pulse oximeter, Monitoring Anaesthesia equipment—if imaging under sedation is in scope

M-Mandatory

Annual Maintenance protocol for equipment and its record maintenance

Films, envelops for reports, CDs/ DVDs for soft copies of report’

M-Mandatory M-Mandatory

List of Drugs and resuscitation equipments

Injector syringes, tubing, i/caths, etc

7 Support Service If applicable

provision for appropriate patient transfer in case of adverse event

8 Legal/Statutory Requirements

Status of registration under Atomic Energy Act

AERB

preferably linked to patient UID

M-Mandatory M-Mandatory

9 Record Maintenance and reporting

Proforma of list of names of patients along with diagnosis and name of referral hospital and date wise record of reports

Availability of reference library including books/periodicals/e-journals/CDs

Yes

D-DESIRABLE

Medicolegal records

Record keeping of technicians and support staff working in X-Ray clinic indicating their details including qualification, registration and training

MLCs; consents for contrast/sedation etc. Yes

M-Mandatory

Duration of record maintenance: As per the Acts and Rules in force

Record of payment of wager and perks

Yes Yes

M-Mandatory M-Mandatory

As per the scope of services

10 Standards on basic processes

Infection Control and waste management practices Yes

M-Mandatory M-Mandatory

Safety considerations – (i) Fire safety (ii) Patient safety Yes

Patient Information and Education Yes

M-Mandatory

Schedule of preparation and dispatch of reports Yes Trolleys for patient transport Yes Calibration of Equipment Yes Grievance Registration and Disposal mechanism Yes

M-Mandatory M-Mandatory M-Mandatory M-Mandatory

Air-conditioning System Yes

D-Desirable

Minimum standards for Imaging Centers – Sonography (Color Doppler) Clinic

1 Definition

Definition of Sonography (Color Doppler) Clinic

USG/ Doppler examination and diagnosis

2 Scope of Services

Enlist the investigations which can be carried out by Sonography (Color Doppler) machine

USG/ Doppler examination of Regions/ parts of body with capabilities of advanced vascular/ cardiac imaging as per the capabilities of the equipment

The Scope should match the Scanner specifications.

3 Physical Infrastructure

Template

Minimum standards

Remark

3a Informative signages

Name of the Radiologist with qualification and PCPNDTcertification and with registration number Display of model of equipment

Broad Services provided

Timings of the facility

Fee structure of different investigations : To be displayed

Yes

M-Mandatory

Safety signage’s (wherever applicable) 3b Safety Hazard and Caution signs

Yes

M-Mandatory

Appropriate Fire exit signages

Yes Yes Yes Yes Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory

Reception and waiting area 4 Space for keeping machine

Reporting room

Toilet

Patient preparation area Electrical facilities

Yes Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory M-Mandatory

Space for keeping patient monitoring apparatus, Recovery area, Resuscitatory appliances for specialized procedures

Yes

M-Mandatory

Furniture & Fixtures

Communication system – Telephone, Fax, internet facility and mobile number for appointment and emergency helpline number of manufacturing company

Water and Electricity

Toilet (male and female wherever applicable)

Yes Yes

M-Mandatory D-Desirable

5 Human Resource

(Full time/Part time/Visiting)

Number of Qualified and registered Radiologists Number of qualified and registered Nurses Number of scavenging and support staff

MD/DMRD Radiology yes

Yes

M-Mandatory

M-Mandatory(as per workload) M-Mandatory

Policy for engagement, posting and rotation of staff Roster of payment and salary of staff

Periodic health check-up and vaccination of staff

Yes Yes Yes

M M D

6 Equipment/instruments/drugs

List of equipments required

List of small instruments required

Annual Maintenance protocol for equipment and its record maintenance

List of consumables, disposables

List of Drugs and resuscitation equipments

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

7 Support Service If applicable

Yes Yes

8 Legal/Statutory Requirements

To be registered under Atomic Energy Act

M;PCPNDT act also

9 Record Maintenance and reporting

Yes Yes Yes

M-Mandatory M-Mandatory

Yes Yes

M-Mandatory

M-Mandatory,Refer to ANNEXURE of Hospital

Proforma of list of names of patients along with diagnosis Yes and name referral hospital

Availability of reference books Yes Medicolegal records, as applicable Yes Record keeping of technicians and support staff working in Yes Sonographycenter indicating their details including qualification, registration and training

M-Mandatory D-DESIRABLE M-Mandatory

Duration of record maintenance: As per the Acts and Rules Yes in force

Statistics to be collected – If felt necessary yes

M-Mandatory M-Mandatory

10 Standards on basic processes Yes Infection Control and waste management practices Yes Safety considerations – Fire safety act

Patient Information and Education Yes Timely preparation and dispatch of reports Yes Trolleys for patient transport Yes Regular calibration of Equipment Yes Grievance Registration and Disposal mechanism Yes Appropriate Air-conditioning Yes

M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory

Template 1 Definition

Minimum Standards

Remark

Definition of CT center

Type of scanner (Slices /Detectors /Energy sources)

Minimum standards for Imaging Centers – CT Scan center / PET CT Scan

2 Scope of Services

Enlist the investigations to be carried out by CT Scanner

CT Scan of Regions/ parts of body with capabilities of advanced vascular/ cardiac/ neurological etc. imaging as per the capabilities of the scanner.

The Scope should match the Scanner specifications

3 Physical Infrastructure 3a Informative signages

Name of the Radiologist with qualification and AERB certification of safety and installation with registration number

Display of model of equipment

Yes

M-Mandatory

Broad Services provided Timings of the facility

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

Fee structure of different investigations : To be displayed

Safety signage’s (wherever applicable)

Yes Yes

M-Mandatory M-Mandatory

3b Safety Hazard and Caution signs

Radiation ÓN’ signage linked with the exposure Radiation signage and symbol as per AERB

Yes Yes

M-Mandatory M-Mandatory

Appropriate Fire exit signages 4 Radiation Safety Measures

Yes

M-Mandatory

RSO level 1

Measures/Devices for radiation protection of staff Measures/Devices for radiation monitoring of staff QC of all equipment, devices and protocols as per AERB guidelines

Yes Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory M-Mandatory

5 Space requirement

Space for keeping machine as per AERB guidelines Space for supplementary equipment like printer, film processor, injector etc

Yes Yes

M-Mandatory M-Mandatory-can be

shared

Reporting room

Reception, report dispatch and waiting area

Toilet

Patient preparation area, change room

Electrical facilities with backup like UPS, Generator Space for keeping patient monitoring apparatus, Resuscitatory appliances and Anesthesia machine Furniture & Fixtures

Communication system – Telephone, Fax, internet facility and mobile number for appointment and emergency helpline number of manufacturing company

Yes yes Yes Yes Yes Yes

M-Mandatory-can be M-Mandatory-can be M-Mandatory-can be M-Mandatory-can be M-Mandatory-can be M-Mandatory-can be

shared shared shared shared shared shared

Water and Electricity

Toilet (male and female wherever applicable)

Yes Yes

M-Mandatory M-Mandatory

6 Human Resource

(Full time/Part time/Visiting)

Number of Qualified and registered Radiologists Number of qualified and registered Nurses Number of CT technicians with training status and support staff

Number of scavenging and support staff

MD/DMRD /DNB Radiology

One/more per center D

One/more per center

Roster of payment and salary of staff

Periodic health check up and vaccination of staff

yes yes

M-Mandatory M-Mandatory

Yes Yes

M-Mandatory M-Mandatory

yes

Qualified with recognised course in Radiology technology, or equivalent

yes

M-Mandatory-can be

shared

7 Equipment/instruments/drugs

List of equipments required

List of small instruments required

As per the scope of services

BP appratus, Pulse oximeter, Monitoring Anaesthesia equipment-if CT under sedation is in scope Films,envelopsforreports,CDs/DVDsforsoftcopiesofreport Injector syringes, tubing, i/caths, etc

List can be provided List can be provided

Listofconsumables

Listcanbeprovided

Annual Maintenance protocol for equipment and its record maintenance

Yes

M-mandatory

Also refer to documents on hospital

List of Drugs and resuscitation equipments

1. Contrast agents;

2. Medication for preparation (e.g. Beta blockers, buscopan etc);

3. Medication for sedation;

4. Medication for resuscitation

8 Support Service

If applicable

Provisionforappropriatepatienttransferincaseofadverse event

Radiation safety Officer

9 Legal/Statutory Requirements

To be registered under Atomic Energy Regulatory Board

M-Mandatory

(AERB)

10 Record Maintenance and reporting

Proforma of list of names of patients along with diagnosis and name referral hospital Availability of reference books

Medicolegal records, as applicable

Preferrably linked to patient UID

D-Desirable

Record keeping of technicians and support staff working in CT Center indicating their details including qualification, registration and training

Yes

MLCs; Consents for contrast/sedation etc. Yes

D-Desirable M-Mandatory M-Mandatory

Duration of record maintenance: As per the Acts and Rules in force

Statistics to be collected – If felt necessary

Yes Yes

M-Mandatory M-Mandatory

11 Standards on basic processes

Radiation Safety Measures and protocols as per AERB Yes requirements

Infection Control and waste management practices Yes Safety considerations – Fire safety act Yes Patient Information and Education and consent

M-Mandatory

Timely preparation and dispatch of reports Yes Trolleys for patient transport Yes Regular calibration of Equipment Yes Appropriate Air-conditioning Yes

M-Mandatory M-Mandatory M-Mandatory

Yes M-Mandatory

M-Mandatory M-Mandatory

1 Definition

Definition of MRI center

MRI examination and diagnosis According to the type of scanner

Template

Minimum standards

Remarks

Fee structure of different investigations : To be displayed

Safety signage’s (wherever applicable)

Yes

M-Mandatory

3b Safety Hazard and Caution signs

Appropriate Fire exit signages

Yes Yes

M-Mandatory M-Mandatory

Metal detector available

4 Space requirement

Reception and waiting area Space for keeping machine Reporting room

Toilet

Yes Yes Yes Yes Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory

Patient preparation area

Electrical facilities

Space for keeping MRI compatible patient monitoring apparatus, Resuscitatory appliances and Anesthesia machine

Minimum standards for Imaging Centers – MRI

2 Scope of Services

Enlist the investigations to be carried out by MRI MRI Scan of Regions/ parts of body with capabilities

The Scope should match the Scanner specifications

3 Physical Infrastructure 3a Informative signages

Name of the Radiologist with qualification Display of model of equipment

Broad Services provided

Timings of the facility

Yes Yes Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory

of advanced vascular/ cardiac/ neurological / functional etc. imaging as per the capabilities of the scanner

Furniture & Fixtures

Communication system – Telephone, Fax, internet facility and mobile number for appointment and emergency helpline number of manufacturing company

Water and Electricity

Toilet (male and female wherever applicable) Yes

M-Mandatory M-Mandatory

5 Human Resource

(Full time/Part time/Visiting)

Number of Qualified and registered Radiologists MD/DMRD Radiology

M-Mandatory(as per workload) M-Mandatory(as per workload) M-Mandatory(as per workload)

Number of qualified and registered Nurses Number of MRI technicians with training status and support staff

Number of scavenging and support staff

Roster of payment and salary of staff

Periodic health check up and vaccination of staff

Yes

Qualified with recognised technology,or equivalent. Yes

Yes

6 Equipment/instruments/drugs List of equipments required

List of small instruments required

As per scope of service

BP apparatus,pulse oximeter,Monitoring anaesthesia equipment-if MRI under sedation is in scope.

M M

Listofconsumables

Films,envelopesforreports,CDs/DVDsforsoftcopies of report .Injector syringes,tubing,i/cath,etc

M-Mandatory

List of Drugs and resuscitation equipments Sterilization equipments

Yes Yes

ANNEXURE on clinic/polyclinic M-Mandatory

M-Mandatory

Annual Maintenance protocol for equipment and its record maintenance

Yes Yes

Yes

M-Mandatory

course

Radiology/MRI

M Advisory

7 Support Service

If applicable

provisionforappropriatetransferincaseofadverse event

Radiation safety Officer

8 Legal/Statutory Requirements

To be registered under PCPNDT Act

AERB

M-Mandatory M-Mandatory D-DESIRABLE M-Mandatory

9 Record Maintenance and reporting

Proforma of list of names of patients along with diagnosis and name referral hospital Availability of reference books

Medicolegal records, as applicable

preferably linked to patient UID

Record keeping of technicians and support staff working in MRI Center indicating their details including qualification, registration and training

Yes

MLCs; consents for contrast/sedation etc Yes

Duration of record maintenance: As per the Acts and Rules in force

Yes Yes

M-Mandatory M-Mandatory

Statistics to be collected – If felt necessary

10 Standards on basic processes

Infection Control and waste management practices

Yes Yes

M-Mandatory M-Mandatory

Safety considerations – Fire safety act and preventing access of steel near the machine.

Patient Information and Education

Timely preparation and dispatch of reports Trolleys for patient transport

Yes Yes Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory M-Mandatory M-Mandatory

Regular calibration of Equipment Appropriate Air-conditioning

Minimum standards for Hospital

ADVANCE ( Non Teaching )

REMARK

1 Scope

Rheumatology services Yes

Services Provided

Superspeciality

2 Human resources

2.1 Doctors

Med person incharge

DM/DNBINRHEUMATOLOGYORTwoYearsStructured Post Doctoral Training in Clinical Immunology and Rheumatology OR MD/DNB MEDICINE WITH 5 YEARS EXPERIENCE OF WORKING IN GOVT RECOGNISED HOSPITAL WITH RHEUMATOLOGYCENTRE.

Full time consultant Part time consultant visiting consultant Duty Doctors

Yes or Yes or Yes

2.2 Nurses

Nursing head

General nurses TrainedNursesforICU/OT/HDU

part of hospital

2.3 Pharmacist Yes 2.4 Para Medical staff

a. Lab Tech Yes b. Xray Technician Yes

yes in inhouse pharmacy

RHEUMATOLOGY SERVICES IN HOSPITAL

FOR PAEDIATRIC RHEUMATOLOGY- DM/DNB/rheumatology or MD/DNB paediatrics WITH 5 YEARS POST MD/DNB EXPERIENCE OF WORKING IN GOVTRECOGNISEDHOSPITALWITH RHEUMATOLOGY. (SPECIAL BEDS IN PAEDIATRICS DESIRABLE)

MBBS Doctor (Mandatory)

MD Med Or MD Pediatrics (Desirable) for round the clock cover

yes

Yes Yeswith6monthsTrainingfromaRheumatologyCenter D

part of hospital

M- if own lab M- if own

c. Technician

e. Dietician

f. Physiotherapist/Occupational Therapist g. Psychologist

h. Medicosocial worker

yes Yes Yes Yes Yes

M-Mandatory(for Minor OT) D

part of hospital

3 Equipment

Diagnostic

USG, RHEUMATOLOGY- MONITORS, INFUSION PUMP, COLOUR DOPPLER (Mandatory)

Emergency

Sterlizing Drugs,Medicaldevicesandconsumables

Yes

Refer to documents on Hospital M-Mandatory

DGCI DMAARDS & IMMUNOSUPPRESSANTS List of disposables Yes

Annual Maintenance records of equip Yes

4 Support Services

4.1. Laboratory Yes 4.2. Imaging Yes 4.3. Pharmacy Yes

own or Outsourced own or Outsourced own or Outsourced

OTOSCOPE, Polarising Microscope, USG with Probe for facilitating Intra Articular Injections, Immunofluorescence Microscope and Video Capillaroscope (Desirable)

Yes

Yes-BIOLOGICALSFORRHEUMATOLOGYrecognisedby

EMERGENCYDRUGS-Alsorefertohospital documents

M-Mandatory

D-Desirable

part of Hospital

Minimum standards for Clinics/ Polyclinics

PAEDIATRIC RHEUMATOLOGY

ADULT RHEUMATOLOGY

Remarks

1 Definition

2 Scope

Specialist

Services Provided

PAEDIATRIC RHEUMATOLOGY OPD Consultation

ADULT RHEUMATOLOGY OPD Consultation

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

M-Mandatory M-Mandatory

4 Human resources

Doctors

DM/DNB RHEUMATOLOGY or MD/ DNB/PAEDIATRICS WITH 5 YEARS POST MD/DNB EXPERIENCE OF WORKING IN GOVT RECOGNISED HOSPITAL WITH RHEUMATOLOGY .(SPECIAL BEDS IN PAEDIATRICS DESIRABLE)

DM/DNB RHEUMATOLOGY OR MD/DNBMEDICINE WITH5YEARS EXPERIENCEOFWORKINGIN GOVT RECOGNISED HOSPITAL WITH RHEUMATOLOGY CENTRE

Tech staff

NURSE-1

EITHER NURSE/ ATTENDANT-M

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS

ATTENDANT-1 Yes

Yes

ATTENDANT-1 Yes

Yes

M-Mandatory D-Desirable

5 Equipment

Stethoscope Thermometer BP Apparatus Glucometer

Yes Yes Yes Yes

Yes (Non Mercury) Yes (Non Mercury) M

RHEUMATOLOGY CLINIC/POLYCLINIC

Weighing machine Others

Yes Yes ophthalmoscope, otoscope(Desirable) ophthalmoscope,

M M-Mandatory

Emergency kit and medicine

otoscope(Desirable) Yes Yes

Refer document on Clinic/Polyclinic

Drugs, Medical devices and consumables

List of disposables

Annual Maintenance records of

Yes Yes

6 support services

sterlization/CSSD security

BMW management Laundry

Yes Yes Yes Yes Yes Yes Yes Yes

M own/outsourced

7 Standard on basic processes a. Receiving patients,privacy for patients while examining especially females

Yes Yes

b. Infection control practices soap and water

Yes Yes Yes Yes Yes Yes

M M M

facilities for hand washing and disinfection

Disinfection of work Area

Use of disposable services small autoclave

Yes Yes Yes Yes Yes Yes Yes Yes

M Yes M D

c. Policy on outsourced services

Yes Yes Yes Yes

M M

Minimum standards for Hospital

BASIC (General purpose)

ADVANCE ( Non Teaching )

REMARK

1 Scope

Providing services ( example Primary Health Centre, Community Health Centre, SDH, District Hospital, Private Hospital,Nursing Homeetc)

Providing services (example Civil Hospital, regional Hospital,Nursing Home,Private Hospital etc of similar scope)

Services Provided

Lung Function Test-spirometry , simple Bronchoscopy – non intervention, Blood Gas

PFT with advance spirometry test including diffusion, Bronchoscopy with advance procedures,CT guided FNAC, Medical thoracoscopy

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

Yes Yes

Yes Yes Yes

2 Human resources 2.1 Doctors

Med person incharge

MD/DNB MEDICINE

with at least 2 mth training in recognized centre in Pulmonology Yes or

Yes or

Yes

MBBS Doctors for round the clock

DM /DNB /MD/Diploma Pulmonology /DiplomainChestDiseasesand Tuberculosis(DCDT)

Yes or

M-Mandatory

Full time consultant Part time consultant visiting consultant Duty Doctors

Yes or

Yes

MBBS Doctors for round the clock

M-Mandatory

2.2 Nurses

Nursing head

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

Yes Yes Yes

Yes Yes Yes Yes

part of hospital

yes-if Inhouse pharmacy

PULMONOLOGY SERVICES IN HOSPITAL

2.4 Para Medical staff Lab Tech

Xray Technician Technician

Yes

PFT Technician Yes

Yes

PFT Technician Yes

Yes

M- if own lab; M- if own M-Mandatory D-Desirable D-Desirable M-Mandatory D-Desirable D-Desirable

ECG Technician Dietician Physiotherapist Psychologist Medicosocial worker

yes yes

3 Equipment

a. Therapeutic

Chest tube,Bipap Machine, Nebuliser, Oxygen, Resuscitation Tray

Chest tube,Bipap Machine, Nebuliser, Oxygen, Resuscitation Tray,Access to ICU

M-Mandatory

b. Diagnostic c. Emergency

Pulse oximeter, PFT

Pulse oximeter, PFT, Tracheostomy set

Yes

M-Mandatory

d. Drugs,Medical devices and consumables

e. List of disposables

f. Annual Maintenance records of equip

Yes (steroids,Nebuliser bronchodilators)

Yes

Yes (steroids, Nebuliser bronchodilators), central line, USG Yes

Yes

M-Mandatory D

4 Support Services

4.1. Laboratory

4.2. Imaging

4.3. Pharmacy

4.4. sterlization/CSSD

4.5. Medical Gas/Manifold

4.6. Blood storage unit/blood Bank

Yes Yes Yes Yes Yes Yes

own or Outsourced own or Outsourced M-IN ADVANCE

Yes

refer to documents on hospital

M-IN ADVANCE D

Minimum standards for Clinics/Polyclinics

Minimum Standards

Remarks

1 Definition

2 Scope

Specialist

PULMONOLOGY OPD Consultation/nebulisation

Specialist

Services Provided

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

M-Mandatory M-Mandatory

4 Human resources

Med person incharge

DM /DNB /MD/Diploma Pulmonology /Diploma in Chest Diseases and Tuberculosis(DCDT) Attendant-1

Yes

M-Mandatory

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS

Yes

Either Nurse/Attendant M-Mandatory D-Desirable

5 Equipment

a. Stethoscope

b. Thermometer c. BP Apparatus d. Glucometer

e. Weigh machine f. Others

Yes

Peak flowmeter,pulse oximeter,heightometer,tape yes

g. Emergency kit and medicine

Refer to document on clinic / polyclinic

h. Drugs,Medical devices and consumables i. List of disposables

j. Annual Maintenance records of equip

Yes Yes Yes

PULMONOLOGY CLINIC

Yes (Non Mercury)

M-Mandatory

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Yes Yes Yes Yes

if required M

if required

7 Standard on basic processes

a. Receiving patients,privacy for patients while examining especially females

b. Infection control practices

Yes

soap and water

facilities for hand washing and disinfection Disinfection of work Area

Use of disposable services

small autoclave

c. Policy on outsourced services

Yes

if required if required

M M M M Yes M D

Minimum standards for Hospital

MEDICAL ONCOLOGY

CLINICAL HAEMATOLOGY

Remarks

1 Scope

Solid Tumors, Haematology

Haematology

Procedures-Bone Marrow Test,Lumbar puncture,Pleural/Ascitic Tap,PICC line insertion,PICC line maintenance, Blood transfusion Services

Services Provided 1.1. Multispeciality 1.2. Superspeciality

yes yes

2 Human resources 2.1 Doctors

Med person incharge

DM /DNB Medical Oncology

DM/ DNB Clinical Haematology

M M

Duty Doctors 2.2 Nurses General nurses

MBBSforroundtheclockcover Yes

MBBS for round the clock cover Yes

M ,part of Hospital

Trained Nurses for ICU/OT/HDU

2.3 Pharmacist

Yes Yes

1 nurse per 2 beds

MEDICAL ONCOLOGY/CLINICALHAEMATOLOGY

1. DM Haematopathology

2. MD Pathology with 03 experience in Haematopathology in recognised institutions can work in Haematology Lab.

For Bone Marrow Transplant-HEPA Filter room,Irradiation of Blood products,Stem cell collection facility,Stem cell cryo preservation facility,Inhouse Blood Bank

30% nurses should have 2 years experience of Oncology from tertiary care centres.

M-Mandatory,with one year training in Oncology, Pharmacology.

2.4 Para Medical staff a.Lab Tech

b. Xray Technician

c. ECG Technician

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

M- if own lab,part of Hospital M- part of Hospital

M- part of Hospital

d. Dietician

e. Physiotherapist f.Psychologist

g. Medicosocial worker

D- part of Hospital D- part of Hospital D- part of Hospital

3 Equipment

a. Therapeutic b. Diagnostic

yes yes

*M–Automated Haematology

c. Emergency d. Sterlizing

Yes Yes Yes Yes Yes Yes

Refer to documents of Hospital M

Refer to documents of Hospital

e. Drugs,Medical devices and consumables

f. List of disposables

g. Annual Maintenance records of equip

Yes Yes Yes Yes

M M

4 Support Services

4.1. Laboratory

Yes Yes

own or Outsourced ( lab with basic facility

4.2. Imaging

4.3.. sterlization/CSSD 4.4. Medical Gas/Manifold

Yes yes Yes Yes Yes Yes

own or Outsourced M

Analyser,Microscope,Haematology Cell counter,Flowcytometer, D-Autopipettes, Cytochemistry stains, Immunohistochemistry, Immunocytochemistry

M-Mandatory D- Desirable

mandatory)

1 Definition

2 Scope

Specialist

Services Provided

ONLY CONSULTATION

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes M Yes M

4 Human resources

MEDICAL ONCOLOGY/CLINICAL HAEMATOLOGY CLINIC/POLYCLINIC

Minimum standards for Clinics/Polyclinics

ONLY CONSULTATION

Remarks

Med person incharge 1.DM/DNBMEDICALONCOLOGY

CLINICAL HAEMATOLOGY a.DM/DNB

2. M

Technical staff NURSE-1 or Non Tech staff Attendant-1 Duty and salary roster Yes

OTHER REQUIREMENT LIKE PERIODIC Yes HEALTH CHECK UPS,vaccination of staff

5 Equipment

Stethoscope Yes Thermometer Yes BP Apparatus Yes Glucometer Yes Weigh machine Yes Emergency kit and medicine Yes

Yes (Non Mercury)

Refer to document on clinic and polyclinic

Medical Oncology b. DM Haematopathology

c. MD Pathology with 03 experience in Haematopathology in recognised institutions can work in Haematology Lab.

Drugs,Medical devices and consumables Yes

Refer to document on clinic and polyclinic

M-Mandatory

List of disposables Yes

Annual Maintenance records of equip Yes

6 support services

sterlization/CSSD Yes security Yes BMW management Yes Laundry Yes

if applicable

M Own/outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients Yes while examining especially females

b. Infection control practices Yes

soap and water Yes facilities for hand washing and disinfection Yes

M M M

Disinfection of work Area Yes Use of disposable services Yes small autoclave Yes facilities for sterlization Yes c. Policy on outsourced services Yes

M M M M D

M-Mandatory

D- Desirable

Minimum standards for Hospital

Basic( General Purpose)

Advance (Non Teaching)

Remarks

1 Scope

eg., Civil Hospital, Regional Hospital,Nursing Home,Private Hospital

Services Provided 1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

Yes

2 Human resources 1.1 Doctors

Med person incharge

Mch Gynaecological oncology from a recognised centre or MD/MS/DNB Gynaecology and Obstetrics with 02 years experience in Gynaecological oncology in a recognised centre

MCh Gynaecological Oncology specialist- Trained in Colposcopy

Duty Doctors

Yes

MBBS Doctors,round the clock cover

2.2 Nurses

Nursing head

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

Yes

1Nurse per 2 patients Yes

yes1forOT

Yes

1Nurse per 2 patients Yes

M M M M

2.4 Para Medical staff Lab Tech

Yes

yes

M- if own lab, part of Hospital(lab with frozen section -M mandatory

yes yes

GYNAECOLOGICAL ONCOLOGY

eg. (General Hospital with Single

Specialities/Multiple Specialities example

Community Health Centre Sub Divisional etc. Of similar scope Hospital ,District Hospital,Civil

Hospital,Private Hospital,Nursing Home) etc

desired

Xray Technician

Yes

M- if own, part of Hospital

OT Technician

yes

Yes

ECG Technician Dietician Physiotherapist Psychologist Medicosocial worker

Yes yes Yes Yes Yes

M-part of Hospital M-part of Hospital D-part of Hospital D-part of Hospital D-part of Hospital

3 Equipment

a. Therapeutic b. Surgical

Basic Surgical Equipment,

DRESSING TRAY, CATHETERISATION TRAY, PORTABLE LIGHT

Basic Surgical Equipment DRESSING TRAY, CATHETERISATION TRAY, PORTABLE LIGHT

M M

c. Emergency

Yes

Refer to Documents on Hospital

d. Sterlizing

e. Drugs,Medical devices and consumables

f. List of disposables

g. Annual Maintenance records of equip

Yes Yes

4 Support Services

b. Laboratory

c. Imaging

d. Pharmacy

g. Medical Gas/Manifold i. Amb service

Yes Yes Yes Yes Yes

Yes yes Yes* Yes* Yes

own or Outsourced own or Outsourced

*M M-own/outsourced/TIE UP

Yes Yes

M M

M-Mandatory

D- Desirable

Minimum standards for Clinics/ Polyclinics

ONLY CONSULTATION

Remarks

1 Definition

2 Scope

Specialist

Services Provided

ONLY CONSULTATION

3 Physical Infrastructure a.Space requirement

i. Reception

ii. consultation/waiting area iii. OPD Area

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

4 Human resources

Med person incharge

MchGynaecologicaloncologyfromarecognised centre or MD/MS/DNB Gynaecology and Obstetrics with 02 years experience in Gynaecological oncology in a recognised centre

Technician

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff

NURSE-1 or Attendant-1 Yes

Yes

5 Equipment

Stethoscope

Thermometer

BP Apparatus

Glucometer

Weigh machine

Emergency kit and medicine

Yes

DRESSING TRAY, CATHETERISATION TRAY, PORTABLE LIGHT

Yes (Non Mercury) Yes (Non Mercury)

Refer to document on clinic/Polyclinic M-Mandatory M-Mandatory

Drugs,Medical devices and consumables List of disposables

Yes Yes

GYNAECOLOGICAL ONCOLOGY CLINIC/POLYCLINIC

M-Mandatory D-Desirable

Annual Maintenance records of equip Yes

6 support services

sterlization/CSSD Yes security Yes BMW management Yes Laundry Yes

M-MANDATORY D

M Own/outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while Yes examining especially females

b. Infection control practices Yes

soap and water Yes facilities for hand washing and disinfection Yes Disinfection of work Area Yes Use of disposable services Yes small autoclave Yes facilities for sterlization Yes c. Policy on outsourced services Yes

M M-MANDATORY M-MANDATORY M

M-Mandatory D- Desirable

Minimum standards for Hospital under CEA

Minimum Standards

Remarks

1 Scope

Services Provided i. Multispeciality

ii. Superspeciality

yes yes

2 Human resources 2.1 Doctors

Duty Doctors

MCh/DNB Surgical Oncology or

MS General Surgery/MS ENT/MS Orthopaedics with 05 years experience in Surgical Oncology in Recognised Centres by MCI,Government Medical College having this course,RCCs.

Yes MBBS Doctors as and when required for round the clock cover

2.2 Nurses

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

2.4 Para Medical staff

a. Lab Tech

b. Xray Technician

c. OT Technician

d. ECG Technician

e. Dietician

f. Physiotherapist

g. Psychologist

h. Medicosocial worker

Yes Yes Yes

M M M

SURGICAL ONCOLOGY

Yes Yes Yes Yes 1 Yes Yes Yes

M- if own lab,part of Hospital M- if own ,part of Hospital M-Part of Hospital

M-Part of Hospital

M-Part of Hospital M-Part of Hospital D-part of Hospital D-part of Hospital

3 Equipment

Therapeutic

Surgical

Diagnostic

Emergency

Sterlizing

Drugs,Medical devices and consumables List of disposables

Surgical Tray Yes

yes

Yes

M ;as applicable

M-Mandatory

Refer to document on Hospital M

Refer to document on Hospital M-Mandatory

Annual Maintenance records of equip

Yes Yes Yes Yes

4 Support Services

4.1. Laboratory

4.2. Imaging

4.3. Pharmacy

4.4.Medical Gas/Manifold

4.5. Blood storage unit/blood Bank 4.6. Amb service

Yes

Yes M-Mandatory

own or Outsourced

M-own/outsourced/TIE UP M-own/outsourced/TIE UP

D- Desirable

Minimum standards for Clinics/Polyclinics

With minor OT

Remarks

1 Definition

2 Scope

Specialist

Services Provided

CONSULTATIONSERVICES;SUTURING,SUTURE REMOVAL, ABSCESS DRAIN, EXCISION LN BIOPSY, DEBRIDEMENT, BANDING, PARACENTESIS, CATHETERIZATION, NEEDLE ASPIRATION, FNAC, MINOR PROCEDURE WHERE NO GA IS REQUIRED

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area iii. OPD Area

Yes Yes Yes

M M M

4 Human resources

Doctors

MCh/DNB Surgical Oncology or MS General Surgery/MS ENT/MS Orthopaedics with 05 years experience in Surgical Oncology in Recognised Centres by MCI,Government Medical College having this course,RCCs.

Technician

Non Tech staff

Tech

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS,vaccination of staff

Yes Attendant-1 NURSE-1 Yes

Yes

D D D D D

5 Equipment

Stethoscope Thermometer BP Apparatus

Yes Yes Yes

Yes (Non Mercury) Yes (Non Mercury)

SURGICAL ONCOLOGY CLINIC/POLYCLINIC

Glucometer

Weigh machine

Emergency kit and medicine

Yes M Yes M

Drugs,Medical devices and consumables List of disposables

Annual Maintenance records of equip

DRESSING TRAY, CATHETERISATION TRAY, PORTABLE LIGHT

Yes

Refer to documents on Clinic /polyclinic

6 support services

a. sterlization/CSSD b. security

c. BMW management d. Laundry

Yes Yes Yes Yes

M Own/outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while examining especially females

b. Infection control practices

Yes

soap and water

facilities for hand washing and disinfection Disinfection of work Area

Yes

Yes M-Mandatory

M M M M M M M D

Use of disposable services

small autoclave

facilities for sterlization

c. Policy on outsourced services

Yes

D- Desirable

Minimum standards for Hospital

BASIC(General purpose)

ADVANCE (Non Teaching Hospital )

REMARK

1 Scope

Providing services for eg. (General Hospital with Single Specialities / Multiple Specialities example Sub Divisional Hospital, District Hospital, Civil Hospital,Private Hospital, Nursing Home) etc For post delivery Newborn care, prevention of Hypothermia , management of low birth weight baby, jaundice

Providing services for Superspecialities example Civil Hospital, Regional Hospital,Nursing Home,Private Hospital etc.

Treatment of babies with respiratory failure,c pap,ventilator,seizure disorder,septicemia,jaundice, LBW and VLBW babies

Services Provided

1.1 General purpose 1.2 Single Speciality 1.3. Multispeciality 1.4. Superspeciality

Yes Yes Yes

2 Human resources 1.1 Doctors

Med person incharge

MD/DNB/DIPLOMA/ PAEDIATRICS /MATERNAL AND CHILD HEALTH FROM RECOG INSTITUTION WITH 03 YRS EXPERIENCE IN NEONATOLOGY – Desirable

MD/DNB/DIPLOMA/ PAEDIATRICS FROM RECOG INSTITUTION WITH 03 YRS EXPERIENCE IN NEONATOLOGY – Mandatory

DM/DNB NEONATOLOGY or equivalent foreign qualification: desirable

OpOphthalmology, ENT experts for follow-up of high-risk neonates Duty Doctors

Yes

1.2 Nurses General nurses

1 per 5 beds 1 per 5 beds

1 per 3 beds 1 per2 beds

M M

Trained Nurses for ICU/OT/HDU

Hospital Infection Control 1.3 Pharmacist

1 D

1.4 Para Medical and other staff

a. Lab Tech

b. Xray Technician

Yes Yes Yes Yes

Yes Yes Yes M

M- if own lab

M-if own

M-(Trained in Breast Feeding and KMC)

c. ECG Technician

d. Dietician(Lactational Councellor)

MBBS Doctors for round the clock cover

Yes

yes, if inhouse pharmacy; part of Hospital

NEONATOLOGY

Yes

e. Physiotherapist

f. Psychologist

g. Medicosocial worker h. Cleaner

yes Yes Yes Yes

D D D

i. Attendant

Yes

3 Equipment

Therapeutic

1. Open care system: radiant warmer, fixed height, servo- controlled with trolley, drawers, O2-bottles , 2) Phototherapy unit 3)Resuscitator(siliconeresuscitationbagandmask withreservoir)hand-operated,neonate,500ml,750 ml, 4) Electronic Weighing Scale,

1. Open care system: radiant warmer, fixed height, servo- controlled with trolley, drawers, O2-bottles ,

2) Phototherapyunit 3)Resuscitator(siliconeresuscitationbagand mask with reservoir) hand-operated, neonate, 500 ml, 750 ml,

21-29: Desirable

Diagnostic Surgical Emergency Sterlizing

ABG machine, glucometer

Chest tube drainage,dressing tray Yes

Yes

M-Mandatory M

5) Electric suction machine /central suction system

4) Electronic Weighing Scale,

5) Electricsuctionmachine/centralsuction system

6) Manual suction machine

7) Thermometer, clinical, digital,

8) Examination Light, mobile

9) Laryngoscope with 0, 1size blade, 10)Washbasin

11) Hub Cutter, syringe

12) Oxygen cylinder/Central oxygen supply 13)fire safety equipment as per requirement 14) ABG machine

15) Pulse oximeter

16) Portable X Ray

17) CPAP machine

18) minimum 3 para monitor(SpO2,HR,ECG) 19) Infusion pumps

20) Ventilator

21) Compressedairlineorstandalone compressors for ventilators

22) Ultrasound machine; Echo optional

Yes

6) Manual suction machine

7) Thermometer, clinical, digital,

8) Examination Light, mobile

9) Laryngoscope with 0, 1size blade, 10)Washbasin

11) Hub Cutter, syringe

12) Oxygencylinder/Centraloxygensupply 13)fire safety equipment as per requirement 14) ABG machine

15) Pulse oximeter

16) Portable X Ray

17) CPAP machine

18) minimum 3 para monitor(SpO2,HR,ECG) 19) Infusion pumps

Appropriate Manpower to ensure adequate disinfection

One per shift: Desirable

Drugs, Medical devices and 10% dextrose,25% dextrose,Calcium 10% dextrose,25% dextrose,Calcium

consumables

gluconate,dopamine,dobutamine,adrenaline,midazo gluconate,dopamine,dobutamine,adrenaline,mid lam,salbutamol,antibiotic as per institutional azolam,salbutamol,antibioticasperinstitutional

Listofdisposables

ETTube,Infusionset,burrete,Disposablesyringe- (1ml,2ml,5ml,10ml,10ml,20ml,50ml ),Umbilical catheter,infant feeding tube(6,8),Oxygen catheter,Sterile glove of various sizes,measuring tap,gown,NIBP,Glucometer

ETTube,Infusionset,burrete,Disposablesyringe- M (1ml,2ml,5ml,10ml,10ml,20ml,50ml

),Umbilical catheter,infant feeding tube(6,8),Oxygen catheter,Sterile glove of

Annual Maintenance

yes Yes

yes

records of equip

4 Support Services

4.1. Laboratory

Hb,TLC,DLC,PS examination/Serum bilirubin/CSF examination/CRP/Blood sugar/Blood calcium estimation.

Yes

own or Outsourced

4.2. Imaging

4.3. Pharmacy

4.4. sterlization/CSSD

4.5 biomedical waste management,

4.5. Medical Gas/Manifold 4.6. Blood storage unit/blood Bank

4.7. Amb service

Yes Yes Yes Yes

Yes Yes Yes

own or Outsourced M-own/outsourced M

5 Process

Protocols and Policies

written protocols in the unit (should cover common neonatal problems, follow-up care, infection control policies, daily ICU routines, etc

protocol,a hand sanitizer,liquid soap,phenytoin,phenobarbitone,Intra Venous Cannula 24g,26g Mucus Extractor, 20 ml, sterile, Oxygen Cylinder,Sterile Gloves,Hand Sanitizer Measuring tape, all I V Fluid.

Yes Yes

M-own /outsourced / TIE UP

M-own / outsourced/ TIE UP

Yes

M- Mandatory

D- Desirable

various sizes,measuring tap,gown,NIBP,Glucometer

Minimum standards for Clinics/Polyclinics

Minimum Standards

Remarks

1 Definition

2 Scope

Specialist

Services Provided

Consultation services,Immunisation Services,upper respiratory tract infection not requiring admission

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

M-Mandatory M-Mandatory

4 Human resources

Med person incharge

MD/DNB/DIPLOMA PAEDIATRICS/MATERNAL AND CHILD HEALTH FROM RECOG INSTITUTION WITH 03 YRS EXPERIENCE IN NEONATOLOGY,DM/DNB NEONATOLOGY

Tech staff

Non Tech staff

Duty and salary roster OTHERREQUIREMENTLIKEPERIODICHEALTH CHECK UPS,vaccination of staff in lab,bld bank,TLD badges

NURSE-1 or attendant-1 Yes

Yes

M M-Mandatory D-Desirable

5 Equipment

Stethoscope

Thermometer

BP Apparatus

Glucometer

Weigh machine(Electronic-Desirable) Emergency kit and medicine

with small chest piece

Yes

small calf for neonate /NIBP

Yes

Yes Midazolam,phenytoin,adrenaline,dopamine,dobutami ne, calcium gluconate, 10% ,25% dextrose,IV fluid

Yes (Non Mercury)

M M;Alsorefertodocumenton clinic/Polyclinic

NEONATOLOGY CLINIC

Drugs,Medical devices and consumables

disposable gloves,sterile syringe,liquid soap,hand M;Alsorefertodocumenton sanitizer,infant feeding tube,iv cannula(24g,26g) clinic/Polyclinic

List of disposables

Yes M Yes D

Annual Maintenance records of equipment

6 support services

sterlization/CSSD security

BMW management Laundry

Yes M

Yes D

Yes M

Yes own/outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while examining especially females

b. Infection control practices

Yes M

soap and water

facilities for hand washing and disinfection Disinfection of work Area

Yes M Yes M Yes M Yes M Yes M Yes M Yes M Yes D

Use of disposable services

small autoclave

facilities for sterlization

c. Policy on outsourced services

Minimum standards for Hospital under CEA

BASIC ADVANCE (General purpose) (Non Teaching Hospital )

Remarks

1 Scope

Providingservices(examplePrimary Providingservices(exampleCivil

Services Provided

1.1. General purpose 1.2. Multispeciality 1.3. Superspeciality

yes

2 Human resources Med person incharge

MS General Surgeon with 03 years experience in Paediatric Surgery from a recognised DNB/MCh centre

MCh/DNB Paediatric Surgery or MS General Surgeon with 03 years experience in Paediatric Surgery from a recognised DNB/MCh centre

Duty Doctors

YesMBBSDoctorsasandwhen requiredforroundtheclockcover

Yes MBBS Doctors as and when required for round the clock

2.2 Nurses

General nurses

Trained Nurses for ICU/OT/HDU

1 nurse per 5 beds 1 nurse per 2 beds

1 nurse per 5 beds

1 nurse per 2 beds;ICU-1:1 on level III bed

Yes

D-Desirable D-Desirable

2.3 Pharmacist

2.4 Para Medical staff Lab Tech

M-part of Hospital

Xray Technician

Yes Yes

M- if own lab,part of Hospital

M- if own ,part of Hospital

PAEDIATRIC SURGERY

Health Centre, Community Health Centre, SDH, District Hospital, Private Hospital,Nursing Home etc)

Hospital, regional Hospital,Nursing Home,Private Hospital etc of similar scope)

yes yes

OT Technician

ECG Technician Dietician Physiotherapist Psychologist Medicosocial worker

Yes Yes Yes Yes Yes Yes

M-Part of Hospital M-Part of Hospital M-Part of Hospital M-Part of Hospital D-part of Hospital D-part of Hospital

3 Equipment

Therapeutic

Surgical Tray

Surgical Tray, Cystoscope ,resectoscope,

M-Mandatory

Surgical Diagnostic

Yes

Upper and lower GI Endoscope/Bronchoscope

Yes

complete CSSD with indicators of all types

Yes

M-Mandatory D

Emergency Sterlizing

Yes Yes

M-ANNEXURE-2 M

Drugs,Medical devices and consumables

List of disposables

Annual Maintenance records of equip

Yes

M-ANNEXURE-3

4 Support Services

4.1. Laboratory

4.2. Imaging

4.3. Pharmacy

4.4. Medical Gas/Manifold

4.5. Blood storage unit/blood Bank

Yes Yes Yes Yes Yes

own or Outsourced

M-own/outsourced/TIE UP

4.6. Amb service

Yes

M-own/outsourced/TIE UP

Yes Yes

M-Mandatory M

Minimum standards for Clinics/Polyclinics

With minor OT

Remarks

1 Definition

2 Scope

PAEDIATRIC SURGERY

Services Provided

CONSULTATION,SUTURING AND SUTURE REMOVAL,INJECTIONS

(No Surgical procedure)

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area

Yes Yes

M-Mandatory M-Mandatory

4 Human resources

Med person incharge

Technician

Non Tech staff

Duty and salary roster OTHERREQUIREMENTLIKEPERIODICHEALTH CHECK UPS,vaccination of staff

MCh /DNB Paediatric Surgery NURSE-1 or

Attendant-1

Yes

M-Mandatory

5 Equipment

Stethoscope

Thermometer

BP Apparatus

Glucometer

Weigh machine(electronic) Emergency kit and medicine

with small chest piece Yes

Yes

Yes (Non Mercury)

Refer to document on clinic/ Polyclinic

M-Mandatory

Drugs,Medical devices and consumables List of disposables

Yes

disposable gloves,sterile syringe,liquid soap,hand sanitizer,infant feeding tube,iv cannula(24g,26g)

Annual Maintenance records of equip

Yes

PAEDIATRIC SURGERY CLINIC/POLYCLINIC

Yes

M-Mandatory D

Yes Yes

6 support services

sterlization/CSSD Yes M-MANDATORY security Yes D

BMW management Yes M

Laundry Yes Own/outsourced

7 Standard on basic processes

a. Receiving patients,privacy for patients while Yes M

examining especiallyfemales

b. Infection control practices Yes M soap and water Yes M

facilities for hand washing and disinfection Yes M-MANDATORY

Disinfection of work Area Yes M-MANDATORY Use of disposable services Yes M

small autoclave Yes M

facilities for sterlization Yes M

c. Policy on outsourced services Yes D

Minimum standards for Clinics/Polyclinics

Minimum Standards

Remarks

1 Definition 2 Scope

Specialist

Services Provided

Consultation Services

3 Physical Infrastructure

a. Space requirement

i. Reception

ii. consultation/waiting area iii. OPD Area

Yes Yes Yes

M-Mandatory M-Mandatory M-Mandatory

4 Human resources

Doctors Tech staff

PG Diploma DPMR, DNB PMR,MD PMR, MS Ortho with training, MD Sports Med with training

M-Mandatory

Non Tech staff

Duty and salary roster

OTHER REQUIREMENT LIKE PERIODIC HEALTH CHECK UPS

Attendant-1 Yes

Yes

M-Mandatory M

as applicable

5 Equipment

a. Stethoscope

b. Thermometer c. BP Apparatus d. Glucometer

e. Weigh machine f. Others

Yes

Exercise Table, Cycling, Weight Dumbbells, Barbells, Cuff Bar

Yes (Non Mercury) Yes (Non Mercury)

g. Emergency kit and medicine

h. Consumables

i. List of Disposables Annual maint of equipt

yes Yes Yes

refer to documents on hospital M-Mandatory (as applicable) D

PMR CLINIC

Occuaptional Therapist, Physiotherapist, Prosthetic ,Clinical Psycologist, Speech Therapist

M-Mandatory (as applicable)

M M M

6 support services

sterlization/ CSSD Yes M

security Yes D

BMW management Yes M

Laundry Yes D-Desirable;own/outsourced

9 Standard on basic processes

a. Receiving patients,privacy for patients Yes M while examining especially females

b. Infection control practices Yes M soap and water Yes M facilities for hand washing and disinfection Yes M Disinfection of work Area Yes M

Use of disposable services Yes M c. Policy on outsourced services Yes D

Minimum standards for Hospital under CEA

Minimum Standards

Remarks

1 Scope

Multispeciality palliative care primarily for oncology, Neurology and HIV patients.This palliative centre can be part of General Hospital or stand alone centre

Services Provided

i. Multispeciality

yes yes

ii. Superspeciality 2 Human resources

Doctors

visiting consultant Duty Doctors

MBBS Doctor and MD Anaesthesia Oncologist,Neurophysician,DoctorstrainedinHIV

2.2 Nurses

General nurses

Trained Nurses for ICU/OT/HDU 2.3 Pharmacist

2.4 Para Medical staff

a. Lab Tech

b. Xray Technician

c. OT Technician

d. ECG Technician

e. Dietician

f. Physiotherapist

g. Psychologist

h. Medicosocial worker

Yes Yes Yes

M-Mandatory M-Mandatory M

PALLIATIVE CARE

MBBS Doctors as and when required for round the clock cover

Yes Yes Yes Yes yes Yes Yes Yes

M- if own lab,part of Hospital M- if own ,part of Hospital M-Part of Hospital

M-Part of Hospital

M-Part of Hospital M-Part of Hospital D-part of Hospital D-part of Hospital

3 Equipment

Therapeutic Yes Surgical Yes Diagnostic Yes Emergency Yes Sterlizing Yes Drugs,Medical devices and consumables Yes List of disposables Yes Annual Maintenance records of equip Yes

as per requirement M-Mandatory (as Applicable) M-Mandatory (as Applicable) Refer documents on Hospital M

Refer documents on Hospital M-Mandatory

4 Support Services

4.1. Laboratory Yes 4.2. Imaging Yes 4.3. Pharmacy Yes 4.4. Medical Gas/Manifold Yes 4.5. Blood storage unit/blood Bank Yes 4.6. Amb service Yes

own or Outsourced

M-Mandatory M-own/outsourced/ TIE UP M-own/outsourced/ TIE UP

1. Examination Table

2. Writing tables

3. Chairs

4. Almirah

5. Waiting Benches

6. Medical/Surgical Beds

7. Labour Table- if applicable

8. Wheel Chair/Stretcher

9. Medicine Trolley, Instrument Trolley

10. Screens/curtains

11. Foot Step

12. Bed Side Table

ANNEXURE FOR HOSPITAL ANNEXURE 1

FURNITURE AND FIXTURES S.N ITEMS

13. Baby Cot- if applicable

14. Stool

15. Medicine Chest

16. Examination Lamp

17. View box

18. Fans

19. Tube Light/ lighting fixtures

20. Wash Basin

21. IV Stand

22. Colour coded bins for BMW

*this is an indicative list and the items shall be provided as per the size of the hospital and scope of service.

EMERGENCY EQUIPMENT

Sr No

Name of Emergency Equipment

Resuscitation equipment including Laryngoscope, endotracheal tubes, suction equipment, xylocaine spray, oropharyngeal and nasopharyngeal airways, Ambu Bag- Adult &Paediatric (neonatal if indicated)

Oxygen cylinders with flow meter/ tubing/catheter/face mask/nasal prongs

Suction Apparatus

4 5 6

Defibrillator with accessories

Equipment for dressing/bandaging/suturing

Basic diagnostic equipment- Blood Pressure Apparatus, Stethoscope,, weighing machine, thermometer

ECG Machine

Pulse Oximeter

Nebulizer with accessories

7 8 9

ANNEXURE 2 EQUIPMENTS

Sl. No.

Name of the Drug

ANNEXURE 3

DRUGS, MEDICAL DEVICES AND CONSUMABLES

List of Emergency Drugs and consumables (Essential in all hospitals)

INJECTIONS

1. INJ. DIAZEPAM 10 MG

2. INJ. FRUSEMIDE 20 MG

3. INJ. ONDANSETRON 8 MG/4ML

4. INJ. RANITIDINE

5. INJ NOR ADRENALINE 4 MG

6. INJ. PHENYTOIN 50 MG

7. INJ DICLOFENAC 75 MG

8. INJ. DERIPHYLLINE

9. INJ CHLORPHENIRAMINE MALEATE

10. INJ. HYDROCORTISONE 100 MG

11. INJ. ATROPINE 0.6 MG

12. INJ. ADRENALINE 1 MG

13. INJ. KCL

14. STERILE WATER

15. INJ. SODA BICARBONATE

16. INJ. DOPAMINE

17. INJ. NALAXONE 400 MCG

18. INJ. LIGNOCAINE 50 ML

19. TAB. SORBITRATE

20. TAB. ASPIRIN

21. INJ. TETANUS

OTHER

22. NEB. SALBUTAMOL2.5 ML

23. NEB. BUDESONIDE

24. LIGNOCAINE JELLY 2%

25. ACTIVATED CHARCOAL

26. CALCIUM (INJ or TAB)

FLUIDS

27. RL 500 ML

28. NS 500 ML

29. NS 250 ML

30. NS 100 ML

31. DNS 500 ML

32. DEXTROSE 5% 500 ML

33. DEXTROSE 10% 500 ML

34. PEDIATRIC IV INFUSION SOLUTION 500 ML

The other drugs and consumables shall be available as per the scope of services, bed strength and patient turnover.

1. Registration under Nursing Home Act/ Medical

Establishment Act 2. Bio-medical Waste

Management Licenses Authorization of HCO by PCB

MOU with Vendor

3. AERB Licenses

4. NOC from Fire Department

5. Ambulance

Commercial Vehicle Permit Commercial Driver License Pollution Control Licenses

6. Building Completion Licenses

7. Lift license for each lift

8. DG Set Approval for Commissioning

9. Diesel Storage Licenses

10. Retail and bulk drug

license (pharmacy) 11. Food Safety Licenses

ANNEXURE 4

LIST OF LEGAL REQUIREMENTS

Below is the list of legal requirements to be complied with by a hospital a applicable by the local/state health authority (all may not be applicable):

Sl. Name of Document No.

Valid From

Valid Till

Send for

Remark

renewal by

(Expired/ valid/NA)

12. Narcotic Drug Licenses

13. Medical Gases Licenses/ Explosives Act

14. Clinical Establishments and Registration (if

applicable)

15. Blood Bank Licenses

16. Boilers Licenses

17. MoU / agreement with

outsourced human resource agencies as per labor laws

18. Spirit Licence

19. Electricity rules

20. Provident fund/ESI Act

21. MTP Act

22. PNDT Act

23. Salex Tax registration

24. PAN

25. No objection certificate

under Pollution Control

Act (Air/Water)

26. Arms Act, 1950 (if

guards have weapons)

S.N. Articles

1. Table

2. Chairs

3. Examination Table/couch

4. Screens

5. Foot Step

6. Stools

7. Storage Cabinet for records etc.

8. BMW storage area

ANNEXURE FOR CLINICS

Annexure 1 C Furniture/fixtures

S. No. 1

Name of the equipment

Minimum Specifications – Adult

No. of equipment

2 3

Oxygen Concentrator/ Cylinder (Portable)

Fire Extinguisher

– Pediatric –

1 1

ResuscitationEquipment Ambu Bag/Air Way

1 1

Annexure 2 C Emergency Equipment

S. No. 1

Name of the Drug

Minimum Quantity

2 3 5 6 7 8

Inj Adrenaline

Inj Hydrocortisone Inj Atropine

InjAvil InjPhenargan

Inj. Deryphyline Inj. Frusemide

2 A

1 vial

1 Ampoule 1 Ampoule 1 Ampoule 1 Ampoule 1 Ampoule

9 10 11 12 13 14

Inj. Metoclopramide

Inj. Dexamethasone

Inj. Diazepam

Inj. Dicyclomine Hydrochloride Inj. 5% dextrose infusion

1 Ampoule 1 Ampoule 1 Ampoule 1 Ampoule 1 Vac

Inj. Normal saline

1 Vac

Annexure3 C Emergency Drugs

Annexures to Minimum Standards for Dental Clinical Establishments Annexure 1

Indicative minimum space requirements for a dental hospital/centre shall be as follows (These are indicative minimum figures, actual size will depend on scope of services of the hospital):

Space Area for one dental Chair

Includes Common and Operatory Areas

100 Sq ft/single chair Dental unit

Common area

Space for reception, waiting area, toilets etc.

35 sq ft

Operatory

Dental Chair unit including washing area and bio medical waste

60 sq ft carpet area for 1 dental chair

Ancillary area/space for sterilization, dark room, storage, provision of compressed air and suction sterilization

30% of the carpet area for 1 dental chair

For every additional chair 50% additional area required.

There should be adequate space between two dental units enough for patient privacy, ease of movement of staff and proper sanitization.

Annexure 2

Following furniture and fixtures shall be available however the quantity shall be as per size of the hospital/centre and workload so as to provide safe and secure patient care:

S.No. ARTICLES

1. Basic Computer and Printer

2. Writing tables

3. Chairs

4. Almirah

5. Waiting Benches/chairs

6. Stretcher

7. Instrument Trolley

8. Screens/curtains

9. Fans

10. Tube Lights / CFL / Bulbs

11. Wash Basin

12.

Colour coded bins for BMW as per state regulations

13.

Small Refrigerator : 1

Note: Stretcher and Screens/curtains are mandatory only for dental hospitals, trauma care centers, those where gen.anesthesia is administered, and where critically challenged patients are admitted.

Annexure 3

Indicative list of minimum Equipment/Instruments /Drugs requirement in a Dental Hospital however the quantity shall be as per size of the hospital and workload so as to provide safe and secure patient care:

I. ESSENTIAL EQUIPMENT LIST FOR PRIMARY ORAL HEALTH DELIVERY and Checking Vital Parameters:

Sl.no.

Equipment

Dental chair with attachments like air motor/air rotor/micro motor

Autoclave

Compressor

Stethoscope

Sphygmomanometer

Suction Unit

Oxygen cylinder with Ambu bag

II. ESSENTIAL INSTRUMENT LIST:

Sl. No.

Function

Instrument

Essential Instrument

Mouth mirror Tweezer Probe Instrument tray

Periodontology

Periodontal probe Scalers

Curettes

Oral Medicine and Radiology

X-ray equipment Lead apron

Oral surgery

Elevators (various) Forceps

Needle Holder Scissors –surgical BP blade and handle

Conservative Dentistry

Filling instruments

Cement spatula (metal/plastic) Waste receiver

Dental hand pieces Excavators

Explorers

Glass slab/paper mixing pad Matrix retainer

Protective glasses

Cellophane strip

Endodontic

Endo root canal explorer Endo root canal plugger Endo root canal spreader

Endo root canal ruler

Spirit lamp or similar instrument for heating purpose

Prosthodontics

Impression trays Rubber bowl Ruler scale Spatula

Carver

Shade guide

Finishing and polishing instruments (e.g Acrylic trimmer, etc)

Wax Knife

Wax Spatula

Cement spatula (metal/plastic)

Waste receiver

Dental hand pieces

Pliers

Glass slab/paper mixing pad

Spirit lamp or similar instrument for heating purpose

Orthodontics

Pliers

Applicable armamentarium

Pedodontics

Relevant instruments as per procedures listed under various specialties.

10.

Implant Dentistry

Implants with surgical kit. Physio dispenser

Other surgical instruments

11.

First Stage Trauma care

Splinting material as per requirement.

III. Essential Drugs list

IV. Essential Emergency Drugs

Sl. No.

Drugs

Local anesthetic with vasoconstrictor

Local anesthetic without vasoconstrictor

Alternate local anesthetics

Sl. No.

Name of Drug

Oxygen

Epinehrine

Atropine

Ephedrine

Hydrocortisone

Nitroglycerine

Antihistamine (diphenhydramine or chlorphenramine)

Albuterol/Salbutamol

9. 10. 11. 12.

Lorazepam

Ethamsylate

Hemostat sponge

Glucose / dextrose-25% ampoule

LIST OF CONSUMABLES

This includes the minimum quantity of the commonly used consumables in the facility which should be made available.

Sl. No.

Category

Item

Common Essential

BP blade

Cotton

Suture

Hypodermic needles – disposable

Saline solution

Burs

Gloves

Masks

Potable water

Disinfectant (general cleaning )

Disinfectant (Instruments) Lubricating oil for hand pieces Soap

Surgical spirit

Periodontology

as per procedural requirements

Oral Medicine and Radiology (Please refer to Annexure 6)

X-ray films

X-ray film developer – manual/automatic processing X-ray film fixer – manual/automatic processing (If digital radiography available in the clinic, the above are optional)

Oral surgery

as per procedural requirements

Conservative Dentistry

Matrix Band Filling Materials Articulating Paper Wedges

Endodontic

Chelating agent paste for root canal preparation

Irrigation solutions Endodontic sealer

Temperory filling materials

GuttaPercha cones –various Files and reamers.

Paper points- absorbent calcium hydroxide

Prosthodontics

Wax Sheet

Green Stick Impression Material Luting Cement

Orthodontics

Wires

Brackets

Adhesive/bonding Materials

Peadodontic

Flouride

Pit and fissure sealant

zinc oxide and eugenol calcium hydroxide

Also relevant consumables as per procedures already listed above

10.

Implant Dentistry

Implants and abutments

11.

Emergency Services

All emergency drugs shall be checked periodically for expiry dates.

Annexure 4

Minimum Human Resource for Dental Hospitals shall be as follows h:

Sl. no.

Category

Strength

Registration with the concerned council (If applicable)

Dentist

State Dental council

Dental Hygienist

Depending on the work load

State Dental council

Dental Assistant / Auxillary

Depending on the work load

–

Dental technician

Depending on the work load

State Dental council

Multipurpose worker

10th Pass

Others

There should be provision of an on call-Anesthetist, General Physician, General Surgeon as and when required.

Annexure 5

LIST OF LEGAL REQUIREMENTS

Below is the list of legal requirements to be complied with by a Dental hospital as applicable by the local/state health authority (all may not be applicable):

Sl. Name of Document Valid Valid Till Send for From renewal

Remark (Expired/ valid/NA)

1. Registration under Nursing Home Act/Clinical

Establishment Act

2. Bio-medical Waste Management Licenses

Authorization of HCO by PCB

MOU with Vendor

3. AERB License for Xray/OPG etc.

4. NOC from Fire Department

5. Lift license (if available)

6. DG Set Approval for Commissioning (if

available)

9. Diesel Storage Licenses

12. Narcotic Drug Licenses

13. Medical Gases Licenses/ Explosives Act

17. MoU / agreement with outsourced human

resource agencies as per labor laws

18. Spirit License

19. Electricity rules

20. Provident fund/ESI Act

25. PAN

27. Wireless operation certificate from Indian P&T

Annexure 6

AERB requirement for OPG/Dental/Mobile Radiography

Please refer to Radiological Safety Division (RSD) DIAGNOSTIC RADIOLOGY SECTION Revised Guidelines for obtaining regulatory consents from AERB for medical diagnostic X-ray equipment

1) Applications for Registration (Radiography/R &F/Mammography/OPG/BMD/ Dental/ Mobile Radiography/ C-Arm) (details given in TABLE-A):

• Completely filled duly signed and stamped application form (AERB/RSD/MDX/REG).

• Layout shall be prepared as per the AERB guidelines for layout and shielding of x-ray equipment.

2) Application for License (Computed Tomography(CT)/ Interventional Radiology (IR) installations) (Details given in TABLE-B)

• Completely filled, duly signed and stamped application form (AERB/RSD/MDX-CT-CATH/LCO & RSO)

• Layout shall be prepared as per the AERB guidelines for layout and shielding of x-ray equipment

3) RSO Approval

• Completely filled, duly signed and stamped application form (AERB/RSD/MDX-RSO)

• Copy of certificates of qualifications (Refer Prescribed qualifications for personnel in DR practice)

• Availability of Personnel monitoring badge (TLD) for which he/she is nominated to become RSO.

MINIMUM STANDARDS FOR

CLINICAL ESTABLISHMENTS OF

AYURVEDA

NATIONAL INSTITUTE OF AYURVEDA, JAIPUR

CONTENTS

Title

Page No

Introduction

Clinic

Dispensary

Therapy Centre

Hospital with minimum of 10 beds

Hospital with minimum of 11-25 beds

Hospital with minimum of 26-50 beds

Hospital with minimum of 51-100 beds

Hospital with more than 100 beds

10.

Teaching Hospitals

11.

General Specifications of OPD

12.

General Specifications of IPD

13.

Support Services

14.

Legal & Statutory Requirements

15.

Records Maintenance & Reporting

16.

Human Resource

17.

Bibliography

18.

Annexures

I. Instruments for the IPD (100 beds)

II. Pathology Laboratory (Central)

III. X- Ray Department

IV. Panchkarma

V. Records to be maintained

VI. Signages

VII. Furniture/fixture requirements for In-Patient Department (IPD)

Introduction

From its gradual evolution through the 18th and 19th centuries, the hospital has come of age only recently during the past 50 years or so, the concept of today’s hospital contrasting fundamentally from the old idea of a hospital as no more than a place for the treatment of the sick. With the wide coverage of every aspect of human welfare as part of health care- like physical, mental and social wellbeing, a reach out to the community, training of health workers, biosocial researches, etc- the health care services have undergone a steady metamorphosis.

A hospital is an integral part of a social and medical organization, the function of which is to provide for the population complete health care, both curative and preventive, and whose out-patient services reach out to the family and its home environment; the hospital is also a center for the training of health workers and for biosocial research.

The society’s health is influenced by the accessibility, affordability, quality, availability and utilization of health services.

Personal health services –

Personal health services are the services provided by the hospitals, health centers, clinics. The care provided has been traditionally classified into –

1. Promotion of health

2. Prevention of disease

3. Early diagnosis & treatment

4. Rehabilitation

The ayurvedic system is the very ancient life science which deals with the prevention and cure of the disease with pronature approach. Today is the era of life style disorders and Ayurveda have a unique approach towards these ailments. So the scope of the Ayurvedic hospital in today’s’ scenario is crucial.

The methodology adopted for this draft is based on the CCIM norms, IPHS guidelines and MSR for Ayurvedic hospitals in Gujarat.

CLINIC

Requirement

Physical infrastructure

Space–100 sq. ft (Minimum)

Human resource

One doctor (Minimum)

One multipurpose worker (Minimum)

Equipment

Stethoscope – 1

B.P. apparatus – 1

Torch – 1

Thermometer – 1

Tongue depressor – 1

Weighing machine – 1

X –Ray view box – 1

Hammer – 1

Others as required

Furniture requirement

Doctor’s table – 1

Doctor’s chair – 1

Chairs for attendants – 2

Examination table – 1

Patient’s stool – 1

Foot step – 1

Others

Display the name of doctor with the degree.

Registration number of the doctor

Fee

Timing of the clinic

Experience of the doctor

DISPENSARY

Requirement

Physical infrastructure

Space–100 sq. ft (Minimum)

Dispensing Counter: as per requirement.

Human resource

One doctor (Minimum)

One Pharmacist (Minimum)

One multipurpose worker (Minimum)

Equipment

Stethoscope – 1

B.P. apparatus – 1

Torch – 1

Thermometer – 1

Tongue depressor – 1

Weighing machine – 1

X –Ray view box – 1

Hammer – 1

Kharala -1

Others as required

Furniture requirement

Doctor’s table – 1

Doctor’s chair – 1

Chairs for attendants – 2

Examination table – 1

Patient’s stool – 1

Foot step – 1

Others –

Display the name of doctor with the degree.

Registration number of the doctor

Fee

Timing of the clinic

Experience of the doctor

Dispensing counter with signage

Name of the pharmacist with degree and experience

THERAPY CENTER

Requirement

Physical infrastructure

Space–150 sq. ft (Minimum) Therapy Room

Human resource

One doctor (Minimum)

One Pharmacist cum Panchakarma Therapist (Minimum)

One multipurpose worker (Minimum)

Equipment

Stethoscope – 1

B.P. apparatus – 1

Torch – 1

Thermometer – 1

Tongue depressor – 1

Weighing machine – 1

X –Ray view box – 1

Hammer – 1

Kharala -1

Others as required

Furniture requirement

Doctor’s table – 1

Doctor’s chair – 1

Chairs for attendants – 2

Examination table – 1

Patient’s stool – 1

Foot step – 1

Panchakarma droni and others as per requirement

Others –

Display the name of doctor with the degree.

Registration number of the doctor

Fee

Timing of the clinic

Experience of the doctor

Display of the therapy performed in the center

Fee structure for various procedures on daily as well as package system.

Sn Requirement

1 Physical infrastructure

2 Human resource

3 Equipment for OPD:

Equipment for IPD:

4 Furniture requirement

5 Others –

Space–

OPD: 100 sq. ft

IPD: 500 sq. ft.

Doctor – 1

Pharmacist/nurse – 1

Attendant – 1

Multipurpose worker – 1

Stethoscope – 1

B.P. apparatus – 1

Torch – 1

Thermometer – 1

Tongue depressor – 1

Weighing machine – 1

X –Ray view box – 1

Hammer – 1

Others as required

Stethoscope – 1

B.P. apparatus – 1

Torch – 1

Thermometer – 1

Tongue depressor – 1

Weighing machine – 1

Enema pot– 1

Tray – 1

Others as required

Iron beds – 10

Beside lockers – 10

Stretcher – 1

Display the name of doctor with the degree. Registration number of the doctor

Fee (both OPD & IPD – daily IPD charges)

Timing of the clinic

Experience of the doctor

Facilities provided

Signage in IPD

Separate toilets and bathrooms for male & females.

HOSPITAL WITH MINIMUM OF 10 BEDS

Sn Requirement

1 Physical infrastructure

2 Human resource

3 Equipment for OPD:

Equipment for IPD:

4 Furniture requirement

Space–

OPD:250 sq. ft

IPD: 1250 sq. ft.

Doctor – 2

Pharmacist – 1

Nurses- 2

Attendant – 1

Multipurpose worker – 1

Stethoscope – 2

B.P. apparatus – 2

Torch – 2

Thermometer – 4

Tongue depressor – 5

Weighing machine – 2

Stethoscope – 3

B.P. apparatus – 3

Torch – 5

Thermometer – 8

Tongue depressor – 4

Weighing machine – 1

Enema pot– 4

Tray – 2

Others as required

Iron beds – as per number of beds Beside lockers – as per number of beds Stretcher – 1

HOSPITAL with 11 – 25 BEDS

5 Others – Display the name of doctor with the degree. Registration number of the doctor

Fee (both OPD & IPD – daily IPD charges) Timing of the clinic

Experience of the doctor

Facilities provided

Signage in IPD

Separate toilets and bathrooms for male & females.

Sn Requirement

1 Physical infrastructure

2 Human resource

3 Equipment for OPD:

Equipment for IPD:

Space–

OPD:500 sq. ft

IPD: 2500 sq. ft.

Doctor: 3-4

Pharmacist: 1-2

Nurse: 3

Attendant: 2-3

Multipurpose worker: 2

Stethoscope – One per OPD

B.P. apparatus – One per OPD

Torch – One per OPD

Thermometer – One per OPD

Tongue depressor – One per OPD

Weighing machine – One per OPD

Stethoscope – 3

B.P. apparatus – 3

Torch – 5

Thermometer – 8

Tongue depressor – 4

Weighing machine – 1

Enema pot – 4

Tray – 2

Equipments used for the panchakarma therapy (as per requirement based on the requirements of 100 bedded hospitals) – optional

HOSPITAL with 26 – 50 BEDS

4 Furniture requirement Iron beds – as per number of beds Beside lockers – as per number of beds

Stretcher – 1

5 Others – Display the name of doctor with the degree.

Registration number of the doctor

Fee (both OPD & IPD – daily IPD charges)

Timing of the clinic

Experience of the doctor

Facilities provided

Signage in IPD

Separate toilets and bathrooms for male & females.

HOSPITAL with 51 – 100 BEDS

Sn Requirement

1 Physical infrastructure

2 Human resource

Space–

OPD:1000 sq. ft

IPD: 5000 sq. ft.

Doctor – 4 – 5

Pharmacist – 4

Nurses – 5

Attendant – 5

Multipurpose worker – 3

Technical staff – optional (as per need of the hospital)

3 Equipment for OPD: Stethoscope – One per OPD B.P. apparatus – One per OPD

Equipment for IPD:

Torch – One per OPD

Thermometer – One per OPD

Tongue depressor – One per OPD

Weighing machine – One per OPD

Stethoscope – 3

B.P. apparatus – 3

Torch – 5

Thermometer – 8

Tongue depressor – 4

Weighing machine – 1

Enema pot – 4

Tray – 2

Equipments used for the panchakarma therapy (as per requirement based on the requirements of 100 bedded hospital)

4 Furniture requirement Iron beds – as per number of beds Beside lockers – as per number of beds

Stretcher – 1

Furniture for panchkarma – as per need (based on the requirement of 100 bedded hospitals)

5 Others – Display the name of doctor with the degree. Registration number of the doctor

Fee (both OPD & IPD – daily IPD charges) Timing of the clinic

Experience of the doctor

Facilities provided

Signage in IPD

Separate toilets and bathrooms for male & females.

HOSPITALS HAVING MORE THAN 100 BEDS

Sn Requirement

1 Physical infrastructure

2 Human resource

Space–

OPD:2500 sq. ft

IPD: 7500 sq. ft.

Doctor – 5 – 10

Pharmacist – 5

Nurses – 5

Attendant – 5

Panchkarma technician – as per requirement Multipurpose worker – 4

3 Equipment for OPD: Stethoscope – One per OPD B.P. apparatus – One per OPD

Equipment for IPD:

Torch – One per OPD

Thermometer – One per OPD

Tongue depressor – One per OPD

Weighing machine – One per OPD Stethoscope – 3

B.P. apparatus – 3

Torch – 5

Thermometer – 8

Tongue depressor – 4

Weighing machine – 1

Enema pot – 4

Tray – 2

Other equipment (List attached in annexure)

4 Furniture requirement Iron beds – as per number of beds Beside lockers – as per number of beds

5 Others –

Stretcher – 1

Others – list attached in annexure

Display the name of doctor with the degree. Registration number of the doctor

Fee (both OPD & IPD – daily IPD charges)

Timing of the clinic

Experience of the doctor

Facilities provided

Signage in IPD

Separate toilets and bathrooms for male & females.

TEACHING HOSPITALS

All the teaching Hospitals must fulfill all the minimum standards as per the gazette notification of Central Council of Indian Medicine (CCIM) regd. no. D.L. 33004/99 no. 115 dated 22.04.2013 New Delhi.

General specifications for OPD –

The basic infrastructure for an outpatient department for an Ayurvedic Hospital must have following sections –

1. Reception and waiting hall

2. Registration counter

3. OPD medical record room

4. Clinic / consultation room

5. Dressing room (mandatory for hospitals having more than 50 beds)

6. Procedure room (mandatory for hospitals having more than 50 beds)

7. Minor OT (optional but mandatory for hospitals having more than 100 beds)

8. Dispensary (mandatory for hospitals having more than 50 beds)

Other facilities which are required in the OPD are listed below –

1. Proper provision for drinking water and electricity

2. Toilet facilities for patients

3. OPD cafeteria (Optional)

1. Reception & waiting area –

The space requirement for the reception & waiting area depends upon the hospital size. It is small for clinic with proper sitting arrangement of patients and attendants. It must be 50 sq. ft. for every 10 beds.

For hospitals having more than 50 beds it must be situated at prominent place of entrance, good communicable. There must be a guide map for various OPD units along with the service unit display.

Waiting area-

Situated at main entrance at reception.

Subsidiary waiting area for the patients at each clinic, diagnostic & therapy rooms for hospitals having more than 5 OPDs.

Waiting area should have tiled floor with comfortable benches and chairs. Waiting area can be used for health education.

Adequate toilet facilities as per the load of the patients. One urinal per 50 persons. Public telephone.

Provision for wheelchairs & trollies.

It must have good drinking water facility & must be well illuminated.

2, 3.Registration counter & record room –

For clinic it must be a small but for the large hospital it may have following requirement –

It is situated at one end of waiting area.

There must be clear distinction between registration counter & medical record room.

The medical record room requires minimum 100 sq. ft. space for medical records for the OPD for hospitals with more than 50 beds where records of both OPD & IPD can be maintained.

4. Consultation & Examination rooms –

Doctor chamber should have at least 10×10 sq ft chamber size with one chair, table for the doctor along with two chairs for the attendant of the patient and one stool for the patient. There should be an examination table of 6×3 ft. dimension. The teaching hospital can develop the consultation rooms in three small block: one for the PG scholar, one examination block and one consultation chamber.

5. Dressing room – A minimum of 100 sq. ft. space is required for dressings in the hospital having more than 50 beds, however it is optional for the hospitals below 50 beds and clinic.

6. Procedure Room – This is required in the hospitals having more than 100 bed strength where agnikarma, kshara karma like procedures can be performed for the OPD patients. However this requirement is applicable for those hospitals that entertain such OPD patients in good numbers. The area depends upon the numbers of procedures.

7. Minor OT – A minor OT is needed for the hospitals with more than 50 beds and 400 – 500 outpatients where many minor OPD surgical procedures as well as Kshara sutra

applications can be performed. The minimum area required for the minor OT is 100 sq.ft.

8. Others – The hospitals having more than 100 beds and having the outpatient number more than 500 can also develop specialty clinics such as Diabetic clinic, Skin clinic, Rasayana & Vajikarana clinic along with special therapy rooms for raktamokshana as per the space availability in the OPD blocks.

9. Proper signage – There must be proper signage in OPD which provides the following information to the visitors –

 OPD timings

 Various OPD clinics with the room numbers and services provided

 Directions of various OPD units

 Complaints and grievances

 Fee

 Toilets

 Cafeteria

 Facilities provided by hospital

 No smoking zone

General specifications for IPD –

Classification of ward accommodation – Primary –

 Bed accommodation

 Nursing station

 Treatment room

Secondary –

 Doctor’s room

 Nurses’ room

 Clean utility

Sanitary –

 Toilet block

 Dirty utility

 House keeper Ancillary –

 Kitchen (required for hospitals having more than 50 beds)

 Day room

 Stretcher trolley

Area per bed must be 50 sq. ft. per bed with the minimum distance between two beds is 3.5 ft. and the minimum distance between two rows of bed must be 5 ft. one nursing station in between two wards with minimum of 100 sq. ft dimensions with one nurse for every 10 beds.

As a general guideline, in the case of Ayurveda specialty hospitals the facilities available should be commensurate and appropriate with the nature of services provided.

The services provided at the hospital shall be consistent with the principles of classical Ayurveda. In particular, diet lifestyle and basic treatment of diseases. Options offered to the patients shall be consistent with that expected from an Ayurvedic medical care facility. Circulation area at least 200 sq. ft. per 25 beds. The doctors’ duty room must have minimum of 100 sq. ft dimension.

Operation Theatre – mandatory for the hospitals having more than 100 beds, however it is optional for the hospitals with less than 100 beds.

Area – 2700 sq. ft.

Functional distribution –

1. Major OT with attached toilet & bathroom

2. Minor OT

3. Scrub room

4. Sterilization store

5. Equipment store

6. Recovery room

Labour room – 300 sq. ft for 100 bedded hospital with duty room. It is optional for hospitals with below 100 bed strength.

Neonatal care room – 150 sq. ft for 100 bedded hospital (Optional).

Panchakarma unit –

Area – 2000 sq. ft for hospitals having 100 beds and more. However the hospitals

having 51 – 100 beds the space requirement is appx. 1000 Sq. ft. and hospitals having less than 50 beds space requirement is appx. 500 Sq. ft. The hospitals having 25 beds or 10 beds can have the space as per the requirement however it is optional for hospitals up to 25 beds.

Specifications is listed below (Hospitals more than 100 beds) –

1. Snehana room male

2. Snehana room female

3. Swedana room male

4. Swedana room female

5. Shirodhara room male

6. Shirodhara room female

7. Vamana room male

8. Vamana room female

9. Virechana room male

10. Virechana room female

11. Basti room male

12. Basti room female

13. Panchakarma therapist room

14. Store room

Auxiliary Functions –

Central laboratory –

Central lab must be located at a place that is easily accessible for all and ideally in between OPD & IPD.

It may have the facility of clinical pathology, microbiology, biochemistry and histopathology.

There must be separate sections for collection, media preparations, sterilization & storage.

There must be provision of waiting area, toilet facilities and result distribution counter.

The area required for the central lab must be 1200 sq. ft. for the hospitals having more than 100 beds while for the hospitals having more than 50 beds, the minimum area is 150 sq.ft. For hospitals below 50 beds it is optional. They can tie up with laboratories.

Radiology –

The minimum area required for the X-ray unit is 150 sq.mt. for hospitals having more than 100 beds. It is optional for the hospitals below 100 beds.

The space can be functionally divided into radiographer room, X-ray room, dark room, drying room, waiting area and report distribution area. An X-ray record room is required in the teaching & training hospitals.

Support services

The hospitals having good outdoor and indoor setup for the management of various ailments of the society cannot perform to the expectation of the society if its supportive services & supply are not up to the mark. So it is a necessity for a good hospital or the small clinic setup that they must have excellent support services. The support services comprise following details –

 Dietary services

 Water supply

 Electricity

 Toilet facilities

 Laundry service

 Housekeeping & sanitation

 Medicine preparation area

 Ambulance services

 Circulation

 Medical records

 Waste management

Dietary services or kitchen –

Kitchen is necessary for the hospitals having more than 50 beds as it is mandatory to provide food the patients admitted in the hospital. Ideally, kitchen should be situated on the ground floor but if it is situated on the first floor, then the ground floor beneath should be used as kitchen.

The area of the kitchen should be 250 ft. for 50 bedded hospitals and 500 sq. ft for the hospitals having 100 or more than 100 beds.

Water supply –

Water supply is essential component of the any hospital. Water closet in IPD is minimum one per 12 beds.

Electricity –

Electricity should be at least 3 hours backup or generator for critical areas. Hospitals having more than 100 beds must have their power substation. The minimum area for power substation is 80 sq. mt.

Toilet facilities – Separate toilets and bathrooms for both male & female patients as per the bed strength of the hospital.

Laundry services – The term linen and laundry services includes the laundering of linen, storage of clean linen and repair and replacement of all linen. The service therefore, has two components –

1. The laundry component responsible for efficient laundry operations.

2. The linen management component comprising procurement, classification,

holding, distribution, repair and replacement of linen.

The linen used in the hospital can be classified into general purpose linen, patient body linen, bed linen and OT, labour and procedure room linen.

Linen requirement- bed sheet: 3 per bed, pillow cover: 3 per bed, blanket: 1 per bed with 20% extra.

Housekeeping & sanitation – maintenance of wards, cleaning of ward areas are functions of housekeeping staff of hospital. In places where sewage disposal system is available, the hospital sewage is directly disposed of into such as central system. Medicine preparation area – A room with minimum 100 sq. ft is required (optional for the hospitals below 50 beds & necessary for the hospitals more than 50 beds). Ambulance service – The hospital with more than 100 beds must have one ambulance.

Circulation route –

The circulation route is of two types: internal & external circulation. The internal circulation comprises stairs, ramps, steps and corridors. Corridors must be more than 8 ft. in width in any hospital with IPD.

Parking –

One parking per 5 beds is desirable for the hospital. The area of the parking depends upon the load of the outpatient & inpatient number. There must be separate parking area for the employees and staff.

Security –

Security of the hospital premises is essential. There must be security personnel deputed in the hospital. The hospital can hire a security service agency which is responsible for the security of the hospital infrastructure as well as the patient’s assets. The monitoring of the visiting hours of the hospital and the public influx is also the responsibility of the security agency. The total number of security deployed in the hospital depends upon the size of the hospital.

Waste management –

Incidences of inappropriate hospital waste disposal and the fear of HIV & other infections have drawn medical attention to hospital waste management practices. Any good waste disposal system should be planned for –

1. Good appearance

2. Safety

3. Pest control

4. Odour control

5. Public health safety

In general classifications of the waste from the final disposal point of view are –

 Type 0 waste (Trash) – such as paper, cardboard cartons, wooden boxes etc.

 Type 1 waste (Rubbish) – such as wood scrap, paper and floor sweeping.

 Type 3 waste (Refuse )

 Type 4 waste (garbage)

 Type 5 waste (pathological)

Biomedical waste –

Biomedical waste must be segregated, disposed and transported through color coded plastic containers and sent to the nearest biomedical waste treatment facility.

Legal & statutory requirements – List of statutory compliance –

 Authorization under Biomedical Waste Rules 2016 for management and handling of biomedical waste.

 No objection certificate from competent fire authority.

 Vehicle registration certificate for ambulance.

 Right to Information Act.

 Consumer Protection Act

 Clinical Establishments Act 2010. Legal aspects –

 Societies Registration Act 1860

 Consumer Protection Act

 Drug & Cosmetic Act

 Patients’ Bill of Right

 Medical negligence

 Drug handling

 Hospital infection

 Anesthesia – given with proper & valid consent.

 Invasion of privacy

 Handling of medical records

Records maintenance & reporting –

Medical records –

The medical record of the hospital has the following documents –

1. A clinical document

2. A scientific document

3. A administrative document

4. A legal document

The characteristics of good medical must be complete, adequate and accurate. Medical record must be properly organized & all the documents are placed safely. Each record should be identified by indexing the record as alphabetical, numerical, serial unit and terminal digit. The record must be placed in the file which is placed in a cabinet. There

must be segregation of the cabinet for the medico legal record, admission record, birth & death records etc.

Retention of records is necessary for the need of the patient up to 7 years, for medico legal record up to 10 years or till the disposal of ongoing cases in any of the courts related to these records.

Computerization of the medical record – very useful for the following:

a. Location monitoring

b. Automatic assignment

c. Improved procedures for generating the admission, discharge, birth, death and

other records.

Reports – (mandatory for the hospitals having more than 100 beds & teaching hospitals)

 Average daily census ward wise, specialty wise

 Average length of stay

 Bed occupancy rate

 Bed turnover rate

 Outpatient clinics – number of new cases, number of repeat cases, specialty wise break up, Unit wise break up of cases

 Left against medical advice (LAMA) rate

 Number of X-Ray done – OPD, IPD

 Number of laboratory investigations

 Number of surgical operations

 Number of panchakarma done – break up of various procedures for OPD & IPD

 Number of deliveries done along with other gynecological procedures.

 Numbers of para surgical procedures done in the breakup of agnikarma,

jalaukavcharana etc.

Hospital Infection control measures –

1. Aseptic techniques

2. Segregation of contaminated instruments

3. Disinfection practices

4. Sterilization practices

5. Isolation facilities

6. Precautions for staff

7. Hygienic dietary practices

8. Aseptic & standard panchakarma procedures.

9. Aseptic leech therapy

Material management –

Operative goals of material management are –

1. Optimum material acquisition

2. Optimum inventory turnover

3. Good vendor relationship

4. Material cost control

5. Effective issue & distribution

6. Elimination of losses & pilferage.

The material management functions cater to planning for material, its demand, estimation, procurement, stocking and issue to ensure the availability of right material, right quantity, at right time, at right price, from right source and in least cost.

The purchasing procedure involves value analysis, rate contracts. Purchase order with supplier’s name, quotation, description of material, price with total value. The store must ensure the received item verified as per order with the proper receipts. The central store of the hospital should have good atmospheric condition & good lighting. It must be well organized making effective use of the space with adjustable, fixed location racking system. There must be allocation of space of various varieties of items stored. Store record should be maintained in the stock register with issue register and disposal register.

Engineering services – Area of the engineering services are –

 Electricity supply to the hospital.

 Water supply

 Repair

 Maintenance

 Expansion

Others –

Ayurvedic specialty hospital, hospital attached with medical education or apex hospitals of Ayurveda can extend their services to the population by developing specialty clinics like Diabetic, cardiovascular, dermatology, respiratory, geriatric, neuromuscular etc. They can also develop separate panchakarma unit for balroga. In indoor, they can develop deluxe and private ward as per the influx of patients.

Human Resource

Essential OPD Staff for 100 bedded hospital –

1. Physicians: All teachers of clinical and other subjects.

2. Casualty Medical Officer: 3 (where Atyayik department exists)

3. Vaidyas: OPD-in-charge:2

4. Kalpak/Pharmacist: 4 (upto 100 patients daily), one for every additional 50 patients. 5. Nurse: 2

6. Dresser: 2

7. OPDAttendant: 3(in addition to Departmental attendants)

8. Clerk (Registration&Record):2

9. Sweeper: 2 or on contract basis

IPD staff for 100 bedded hospitals –

The minimum staff required in a 100-bed non-teaching hospital, liable to be increased proportionately in accordance with bed strength, shall be as given below.

3. hospital

4. Resident Medical Officer

5. Nursing staff, Panchakarma technicians as per General Structural standards.

6. Consultant Dietician (Ayurvedic)

7. Canteen staff- Cook and minimum 1 helper for every 50 patients &

bystanders served

Medical Superintendent

Dy. Medical Superintendent

Consultant Physicians- depending on scope of services offered by the

8. All other staff- commensurate in number and availability, for scope of services offered by hospital, and to fulfill the quality of service standards stated in the quality management system of the hospital.

Details specifications of staff for 100 bedded hospital is as given below –

Post

Requirement

Medical Superintendent

Principal or Dean as ex-officio.

Deputy Medical Superintendent

Full time regular incumbent with postgraduate qualification in a clinical specialty.

Consultants

Teachers of clinical departments including Swasthavritta and Yoga Department.

Casualty Medical Officers

4 (2 Ayurveda and 2 Allopathic on contract)

House Officers or Clinical Registrars/Senior Residents (Ayurveda)

2 for Kayachikitsa department and 1 each for all other clinical departments.

Resident Medical Officers/Surgical

Officers (RMO/RSO)

1 RMO and I RSO for 100-bedded hospital and both 1 extra each for every

50 additional beds.

Matron / Nursing Superintendent

Assistant Matron

1 for 100 beds and

1 extra each for every 50 additional beds.

Staff Nurses for IPD

1 for every 10 beds.

10.

Nurses for OPD

2 for OPD attendance up to 150 patients and 1 extra each for additional 100

11.

Mid Wife/Ward Boy/Ayah

patients.

1 for every 10 beds – (10).

12.

Pharmacists

4 (2 for OPD and 2 for IPD of 100 beds) and 6 above 100 beds (for OPD and IPD both).

13.

Dresser

14.

OPD attendants

3 plus teaching departmental attendants will also work in the hospital.

15.

Store Keeper

16.

Office Staff (f o r registration, record maintenance, data entry

17.

etc.)

Dark-Room Attendant

18.

Operation Theater Attendant

19.

Labour Room Attendant

20.

Telephone Operator cum Receptionist

4 (8 hrs. duty)

Modern Medical Staff (on contract)

Medical Specialist

Surgical Specialist

Obstetrician & Gynecologist

Dentist

Refractionist

Audiometrist

Radiologist

1 (Postgraduate in Allopathic Radiology or

Vikiran Vigyan of Ayurveda

discipline)

from teaching department of Shalya.

X-Ray Technician/Radiographer

Medical Specialist

Surgical Specialist

Panchakarma Specialists

Teachers of Panchakarma teaching department.

House Officer /

Clinical Registrar/

Senior Resident (Ayurveda)

Panchakarma Technician

4 (2 Male + 2 Female)

Panchakarma Assistant

2 male and 2 female

Yoga teacher/expert

1 (from Swasthavritta & Yoga Department)

Sweepers

Staff of Operation Theatre and Ksharasutra Therapy

Shalya and Ksharsutra Therapy Specialists

Teachers of Shalya department

House Officer/ Clinical Registrar/Senior Resident (Ayurveda)

Operation Theatre Attendant

Dresser

Nurses

2; these will be in addition to the nurses indicated at sl.no. 9.

Sweeper

Shalya and Ksharsutra Therapy Specialists

Teachers of Shalya department

Labour room

Prasooti evum Stri Roga Specialists

Teachers of Prasooti evum Stri roga department

Lady House Officer or Clinical Registrar/Senior Resident (Ayurveda)

Nurses

2; these will be in addition to the nurses indicated at sl.no. 9.

Midwife

Attendant

Sweeper

Pathologist/Microbiologist for Hospital & College

Bio-chemist for Hospital & teaching work

Laboratory Technicians

Laboratory Assistants

Clerk/Typist/Computer Data Entry Operator

Sweeper

Peon/Attendant

Machine Man

Workers

Analytical Chemist

1 (For teaching as well as Q.C.)

Pharmacognosist

1 (For teaching as well as Q.C.)

Bibliography

1. Anand RC, Satpathy – Hospital waste management: a holistic approach 2nd edition 2000.

2. Francis CM, D Souza C Mario – Hospital administration 3rd edition 2000.

3. Gill R – Hospital and law, Hospital administration 21 (1 and 2). 1984

4. Gupta Shakti Kumar, Kant Sunil, Chandrashekhar R, Satpathy Sidhartha – Modern

trends in planning and designing of hospitals principles and practice. 1st edition

2007.

5. Indian Public Health Standards (IPHS) Directorate General of Health Services

Ministry of Health & Family Welfare, Government of India. Revised Edition 2012.

6. Sarkar BM – Principle of hospital administration and planning Jaypee brothers

medical publication (P) ltd 2nd edition 2009.

7. http://www.ayurvedauniversity.edu.in

8. http://www.ccimindia.org

9. http://www.clinicalestablishments.gov.in

10. http://www.gujarathealth.gov.in

11. http://www.indianmedicine.nic.in

ANNEXURE I

Instruments for the IPD of 100 bedded hospital

Sn. Name of Article No.

1. Iron beds simple 64

2 Iron beds(Surgical) 20

3 Iron beds(children) with sides closed 6

4 Iron bed with cradle 10

5 Fowler’s bed 10

6 Bedside lockers 100

7 Bed head tickets holders 100

8 Temperature chart holders 100

9 Spittoon with stands 50

10 Office table

11 Office chair

12 Racks

13 Linen Box

14 Dirty linen boxes

15 Stretcher

As per requirement As per requirement 6

16 Trolley

17 IV stands

18 Screens(folded)

19 IV Sets with boxes

20 Blood Transfusion

21 Rectangular Trays

22 Enamel Bowels

23 BP Instrument

24 Bed Pan EI

25 Urine Pots, Male &

26 Ice Bags

27 Hot Water Bags

28 Air Cushion

29 Ryles Tube

30 Stomach Tube

31 Bucket EI

32 Tongue Depressor

33 Suction Machine

34 Suction tube

35 Artery Forceps, Small and Big 20

sets

with cover lid 10

Female 40(20+20) 5

As per requirement As per requirement

10 10 20

36 Back rest 10

37 Oxygen Cylinder with stand 10

38 Thermometers 10

39 Syringes (2cc 4cc) 10

40 Dressing Drums (Big) 10

41 Stools, either wooden or steel 100

42 Tracheotomy Set 5

43 Enema Pot with Nozzle and Tube 20

44 AutoScope 4

45 FundoScope 2

46 RetinoScope 2

47 LaryngoScope 2

48 Endotracheal Tubes different sizes 6

49 Feeding cup 10

50 Enema Syringes 20

51 Infra-red lamp 2

52 Torches 10

53 Scissors 10

54 Sputum Mugs 10

55 Measuring Glasses 10

56 Steel Almirah 6

57 Chair Trolley with Wheels 2

58 Refrigerator 1

59 Trolley different sizes 10

60 Wastage Trolley 3

61 Thermos Type of Kettle for Tea/Milk (50 Cup size) 02

62 Thermos Type of Kettle for Kwath (different sizes) 02

63 Examination table 8

64 ECG Machine 3

65 Nebulizer 3

66 Wheel Chair 4

67 Hot plate 2

68 Glucometer 4

69 Weighing machine 4

ANNEXURE II

PATHOLOGY LABORATORY (CENTRAL) S.No. Name

1. Beakers Different sizes

2. Micro Pipettes Different sizes

3. Spirit Lamps

4. Capillary Tubes

5. Test Tubes(Medium)

6. Test Tube (small)

7. Blood Grouping Tiles

8. Centrifuge Machine

9. Incubator

10. Oven

11. Microscope (Binocular)

12. Refrigerator

13. F.S.R.Westergren’s Racks

14. F.S.R.Wintrobe’s Racks

15. Metal Racks (small tube)

16. Small Tube Racks Plastic

17. Hemoglobin Meter

18. Neubar’s Chamber

19. Micro tone No.1

20. Micro tone o.4

21. Stop Watch

22. Tourniquet Belts

23. Centrifuge Tubes(Plastic)

24. Water Bath

25. Auto Analyzer

26. Rotary Machine Timer Remi Equipments

27. Computer

28. ELISA Test Machine

29. F.S.R. Machine (auto) Micro Sed

30. Fridge

No.

10 10

1 Box 100 150 2

ANNEXURE III

X RAY DEPARTMENT

1.X-Ray 300 Ma

2.Cassettes

3.X-Ray films (Different Sizes) 4.Film Dryer

5.View Box

6.Hanger

7.Dark Room

8.Fixures/ Developer Etc. 9.Lead Apron

10.Cylindride Core

As Per Requirements

ANNEXURE IV PANCHKARMA

Poorva Karma

I. Snehana Karma Essential Items

1.Separate Unit is proposed for male & female

2.Complete bedding/cot one for male, one for female Rooms (One)

Equipments/Instruments

1. Measuring glasses

i)200ml. 2

ii)100 ml. 2

iii)50 ml. 2

2. Simple steel glasses 6

3. Gas/Stove/heater with fittings 1

4. Lighter/Matchbox 1

5. Abhyanga (Massage)Table/Droni 2

6. Steel bowls

i)50 ml. 6

ii)100 ml. 6

7. Towels, Dusters 12

8. Plastic aprons 4

9. For Shirodhara

(i)Shirodharayantra 2

(ii)Stand 2

(iii)Dharapatra 2

10. For Shirobasti

i) Plastic Caps/Leather caps

ii) Large 2

ii) Medium 2

iv)Small 2

11. Holder (Chimata/Pakkad) 2

12. Big spoons, Tea spoons 4

13. Steel Pots (Patila)

i)2 litre 2

ii)1 litre 2

Materials

1. Til Oil

2. Dashmoola Oil

3. Different Medicated Oils

4. Masjapishta (Blackgram Flour)

5. Bandage

6. Cotton

7. Gauge Piece

Pradhana Karma

I. VAMANA KARMA

Essential It

1. Rooms/Chamber(2) Preferably with attached toilets

2. Instruments/Equipments

1. Measuring glasses

i) ii) iii) iv)

2. Buckets/Plastic tubs/Basin(with provision of measuring scale) 2

3. Towels/Napkins 6

4. Plastic Aprons 6

5. Kharala/Mostar 2

6. Gas/Stove 1

7. Big steel patela 5 litre 2

8. Steel jug/Plastic jug 2

9. Steel glasses 4

10. Bowls-100 ml. 4

11. Table spoons 4

12. Vamanpeetha (Adjustable chair) 2

13. Cots with complete beddings 2

14. Dhumapana Yantra 2

15. Spittoons 2

16. Rubber Catheters 4

1 litre 2

200 ml. 2

100 ml. 2

50 ml. 2

Materials

i) Vamaka dravya

ii) Vamanapaga dravya

iii) Emergencydrugs

VIRECHANA KARMA BASTI

Essential items

1 Rooms (2) fitted with toilet and bathroom (common) 2. Equipments/Instruments

i) Basti Yantra (4) Enemapot

ii) Niruhabasti Yantra (4)

iii) Anuvasanabasti Yantra 4

iv) Uttarabasti Yantras (Douche cane fitted with rubber tube and nozzle of various sizes)

v) Urinary catheters (Rubber and metallic) Different Nos. For Females

i) Sim’s speculum

ii) Cusco’s Speculum

iii) Anterior Vaginal wall retractor iv)Vulsellum

3. Uterine sound

4. Bladder sound (Urethral dilators) of different sizes

5. Kharal

6. Basti Netra (Metalic)

7. Bowls

8. Rubber Sheets

9. Focus lamp/Torch

10. Gynaecological Table with attachment for Lithotomic position

11. Easy chairs

12. Cotton

13. Gauze pieces

14. Sponge holding Forceps

15. Cots with complete beddings

16. Revolving stools

17. Bedpans

18. Towels/Napkins-one towel/bed for female & central hole

19. Measurig glass 1 litre

20. Teaspoon, Tablespoon

21. Plastic aprons

2 (Common)

2 4

4 6 6

22. Buckets 2

23. Glycerine Syringe 4

24. Glass/Plastic syringes

i) 100 ml. 4 ii) 50 ml. 4 iii)20 ml. 4

Material

i) Bastidravya for various types of basti, Gudavarti

ii) Medicines for management of Vyapada

NASYA Essential Items

1. Rooms

2. Equipments/Instruments

2(Common)

i. Nasyapeetha (Chairs)

ii. Adjustable Tables

iii. Droper/Droper bottles

iv. Cotton

v. Gauze

vi. Pradhamana Nasya Yantra

vii .Dhuma Yantra

viii. Kharal

ix. Steel glasses

x. Bowls

100 ml.

50 ml.

xi. Steamer (Facial Steam)

3. Material

i. Different types of Nasyadravya, Medicines for complications, Gandusha Dravyas and Dhumpana dravyas

ANNEXURE V

Records To Be Maintained By Clinical Establishments

The various medical records to be maintained by clinical establishment:

1. Outpatient Register

2. Inpatient Register

3. Operation Theater register

4. Labor room register

5. MTP registers (if registered under the MTP Act)

6. Case sheets

7. Medico legal register

8. Laboratory Register

9. Radiology and imaging register

10. Discharge summary

11. Medical certificate in duplicate

12. Complaint register

13. Birth register (Notified to such medical officer as authorized

14. Death register by Government in such format as prescribed by Government/

State level authority)

15. Information in terms of government programmes / areas of work (eg maternal

health, child health, immunization, family planning, Vector borne disease, NLEP,

RNTCP, IDSP. NRHM initiatives-ASHA, JSY)

16.Number of beds system-wise and specialty-wise in Clinical Establishments

providing in- patient care (e.g General Med/Surg. Beds; Special Care Beds) 17. Total Discharges

ANNEXURE VI Signages

1. Display of all radiation hazard signage in radiation areas (if applicable).

2. Display of Biomedical waste segregation at all location where BMW bins are

kept

3. Display of danger signage at all electric panels and other dangerous areas

4. Display of General instructions like ‘No Smoking’, ‘Keep Silence’, ‘Use

dustbin’, etc. at various patient and visitor areas in the hospital

5. Display of hand–washing techniques compliant with WHO guidelines at all

hand wash basins

6. Display of how to use fire extinguisher at all point where fire extinguisher is

installed

7. Display of important phone contact numbers of hospital authorities

8. Displays required by regulations like PCPNDT, Lifts, Fire, etc.

9. Display of Material Safety Data Sheet at all locations where Hazardous

Materials are stored

10. Display of patient rights and responsibilities in OPD, emergency and wards

11. Display of safety instructions in areas where any kind of safety hazard may

be expected. This includes areas like transformers, Cylinder storage, LPG

storage etc.

12.Emergency exit signage (preferably in auto illumination material, like

radium)

13. Fire Protection

14. Hazards- electrical, fall, pipe locations, prohibited areas

15. Notice board for general information to staff

16. Notice board in front of all OPD and Wards.

17. Notice board in Operation theatre

18. Routes for all areas

19.Signage for parking. (Signage for ambulance parking shall be separately

mentioned)

20. Safety signage will be displays as per the requirements of respective Indian

Standards: Ex. Fire Protection Safety Signs IS 12349:1988

ANNEXURE VII

Furniture/Fixture Requirements for In-Patient Department (IPD)

Sr. No.

Name of the Equipment

Min. 10 bedded Hospital

Up to 25 bedded Hospital

26 – 50 bedded hospital

51 – 100 bedded hospitall

>100 bedded hospital

Teaching hospitals

Ad1e.quate wall or steel Cupboards

Optional

Arm Board Adult

Optional

Back rest

Bain Marie trolley stainless steel 1 per floor

1 per floor

Bed side cabinets

1 per 5 patients

Bed side Screen

1 per ward or full length curtains between the beds

Bucket Plastic

Ceiling Fans

As per requirement

Clock 1per ward

1 per ward

10.

Containers for kitchen

As needed

11.

Doctor’s chair for OP & ward,

As needed

12.

Doctor’s or Office table

13.

Dressing trolley-1 per floor/ ward depending on layout

14.

Dust bins in each ward & consultation room

15.

Duty table for nurses

16.

Emergency

1 per floor

resuscitation kit

17.

Enema Set

18.

Fire extinguisher

ABC 1 per ward/ floor based on layout

19.

Foot stools

20.

Fridge

1 Per Area/ Ward

21.

Heavy duty Torch light

1 per ward

22.

Hospital Cots

As per beds

23.

Hospital Cots Pediatric

Optional

24.

Hot Water Bags

2 per ward

25.

Hot Water geyser

2 per ward

26.

I V Stands – 2 per 10 beds

100

27.

Infra-Red lamp

Optional

28.

Intercom System

2 per ward

29.

Kidney Trays1 per 5 beds

30.

Kitchen utensils

Adequate

31.

Massage table of 7ft. x 2.5ft (wood or fibre)

Optional

One per procedure room

32.

Medicine trolley

1 per ward

33.

Office chairs

34.

Office Table

35.

Patient Beds with side rails

20% of total beds

36.

Patient call Bell System

Optional

1 per bed

37.

Patient locker

Optional

1 per bed

38.

Patients examination table– 1 per ward/ floor a per the profile of

– 1 per ward/ floor a per the profile of patients & layout of facility

patients & layout of facility

39.

Patients side table

1 per bed

40.

Pediatric cots with railings as per scope of services

as per scope of services

41.

Steel or Wooden cup board

42.

Steel rack

43.

Stool 1Per Bed

44.

Stools revolving – 1 per ward

1 per ward

2 per ward

45.

Stretcher/ Patient trolley – 1 per ward

1 per ward

46.

Urinal Male and Female

100

47.

Waiting chairs / benches for patients relatives

50% of the bed strength

48.

Weighing Machine

1 per ward

49.

Wheel chair

2 per 50 beds

50.

Wooden massage bed

One

One per service room

51.

X-ray viewer

one per ward

MINIMUM STANDARDS FOR

CLINICAL ESTABLISHMENTS OF

UNANI

UNANI STANDARDS FOR

1. Clinics

2. Hospitals with 1 to 50 beds

3. Hospitals with 51 to 100 beds

4. Hospitals with 101 to 200 beds

5. Hospitals with 201 and above beds

CONTENTS

SL TITLE PAGE A Introduction

A.1 General A.2 Scope

B. Functions

B.1 Core functions (Clinical services)

B.2 Auxiliary Functions (support services)

C. Physical Facilities

C.1 Space requirement

C.1.1 Minimum area

C.1.2 Functional space

C.1.3 Dimensions of the sub areas C.1.4 Basic signage

C.1.5 Others

C.2 Furniture & Fixtures

C.2.1 Furniture/Fixture Requirements

C.2.2 Sundry Articles

C.2.3 Others

C.3 Engineering Services Requirements

C.3.1 Electrical Requirements

C.3.2 Plumbing Requirements

C.3.3 Civil Requirements

C.3.4 HVAC / AC / Ventilation / Cross Ventilation Requirements C.3.5 Others*

C.4 Public Utilities

C.4.1 Potable drinking water

C.4.2 Sanitary Requirements

D. Equipment /instruments D.1 Therapeutic equipment D.2 Surgical equipment

D.3 Diagnostic equipment D.4 Emergency equipment D.5 Sterilizing Equipment

E. Manpower

E.1 Medical practitioners E.2 Therapists

E.3 Paramedics

E.4 Nurses

E.5 Administrative staff

47 47

48 50

51 51 51 56

57 58 59 59 62

63 63

63 63 65

65 65 65 65 65

66 69 71 73 75

74 75 76

79 80

F. Drugs

F.1 Anaesthetic drugs

F.2 Emergency drugs

F.3 General Drugs

G. Consumables

G.1 Surgical

G.2 Dressing Material

G.3 Disinfectants

G.4 Tubing

G.5 Linen

G.6 Stationery

G.7 Adhesives and gels

G.8 Others*

H. Licenses

I. Basic Processes

I.1 Registration

I.2 Assessment

I.3 Infection Control

I.4 Safety considerations

I.5 Clinical Treatment Records

A. Introduction

As for the present state of Unani Medicine in India, the country has the largest infrastructure of academic, research and healthcare institutions of this system. There are 41 educational institutions of Unani Medicine in the country that are recognized by Central Council of Indian Medicine (CCIM), a statutory body established by Government of India by an Act of Parliament, the Indian Medicine Central Council (IMCC) Act, 1970. The health care services have undergone a steady transformation with the wide coverage of every aspect of human welfare as part of health care- like physical, mental and social wellbeing, a reach out to the community, training of health workers, biosocial researches, etc.

A hospital forms an integral part of a social and medical organization, the function of which is to provide for the complete healthcare in terms of both curative and preventive aspect. The hospital is also a center for the training of health workers and for biosocial research. The health is influenced by the accessibility, affordability, quality, availability and utilization of health services.

Traditionally the aim of healthcare facility is to provide Promotion of health, Prevention of disease, Early diagnosis & treatment and Rehabilitation.

Functions of the hospital –

Intramural functions –

1. Restorative – Diagnostic, Curative, Rehabilitative, Emergency care

2. Preventive

3. Education – Medical UGs & PGs, Paramedical

4. Research

Extramural functions –

1. Outpatient services

2. Outreach services

3. Mobile clinics

4. Medical care camps

The health care in Unani system of Medicine is provided at various levels –

1. Dispensaries (Clinics)

2. Hospitals having bed strength up to 50

3. Hospitals having bed strength up to 100

4. Hospitals with bed strength more than 100 up to 200 (Teaching and Training)

5. Hospitals with more than 200 bed strength (Teaching and Training)

A.1 General

The standards thus framed are on account of the minimum requirement of this category of healthcare provider. There are no exclusions. They are dependent on the basic functions of the unit/hospital/provider. All sections mentioned are mandatory and include both structure and basic processes.

A.2 Scope

This includes the services being provided by the facility to which the standards will be applicable (For example common minimum standards framed for a polyclinic are applicable to a polyclinic only and not to a single specialty hospital)

Now a days the role of hospital has changed with the emphasis shifting from –

1. Acute to chronic illness

2. Curative to preventive medicine

3. Restorative to comprehensive medicine

4. In patient care to outpatient & home care

5. Individual orientation to community orientation

6. Isolated functions to area wise or regional function

7. Tertiary & secondary to primary health care

8. Episodic care to total care

Unani system of Medicine is an ancient healthcare system which deals with the prevention and cure of the disease with an ecological approach. Today is the era of life style disorders and Unani system of Medicine has a unique approach towards these ailments. So there is considerable scope of the Unani hospital today. The scopes are –

1. Health Promotion

2. Disease Prevention

3. Diagnosis of disease

4. Cure of the patients

Services –

Services

Clinic

1 – 50 beds

51 – 100 beds

101- 200 beds

201 & above beds

Preventive

Yes

Diagnostic

Yes

Therapeutic

Yes

Follow up

Yes

Rehabilitative

Yes

Scheduled

Yes

Unscheduled

Yes

B. Functions

This section includes the basic services provided by facilities. It is subdivided into two parts

B.1 Core functions (Clinical services)

(Clinics & Outdoor Patients facilities of health care organizations with bed strength of 1 to 50, 51 to 100, 101 to 200 & 201 and above.

Minimum Clinical Services to be provided

Clinics

1 to 50 beds

51 to 100 beds

101 to 200 beds

201 and above

Moalijat

Moalajat

Amraz-e-Jild wa Zohrawi

Optional

Amraz-e-Jild wa Zohrawi

Jarahat

Optional

Jarahat

Ain

Optional

Uzn, Anaf, Halaq- wa-Asnan

Optional

Uzn, Anaf, Halaq-wa- Asnan

Tahaffuzi wa samaji Tibb

Optional

Tahaffuzi wa samaji Tibb

Ilaj bil Tadbir

Optional

Ilaj bil Tadbir

Qabalat wa Amraz-e-Niswan

Optional Only antenata l care and Amraz – e Niswan

Qabalat-wa-Amraz-e-Niswan

Amraz-e-Atfal

Optional

Amraz-e-Atfal

Izterari (Casualty)

Optional

Ilaj bit Tadbeer

Dry Cupping

optional

Dry Cupping

Wet Cupping

Optional

Wet Cupping

Fasd

Optional

Fasd

Dalak

Optional

Dalak

Riyazat

Optional

Riyazat

Natool

Optional

Natool

Pashowya

Optional

Pashowya

Hammam

Optional

Hammam

Taleeq

optional

Taleeq

Indoor patients facilities

The indoor department of the hospital shall have separate male and female wards and distribution of beds at the rate of 65 sq. meter area per bed ward as under –

Indoor patient’s facilities:

The indoor department of the hospital shall have separate male and female wards and distribution of beds at the rate of 65 sq. ft. area per bed ward as under –

Minimum Services to be provided

In 1 to 50 beds

51 to 100 beds

101 to 200 beds

201 and Above

Moalijat

Amraz-e-Jild wa Zohrawi

Jarahat

Optional

Jarahat

Ain

Optional

Uzn, Anaf, Halaq-wa- Asnan

Optional

Tahaffuziiwa samaji Tibb

optional

Tahaffuziiwasamaji Tibb

Qabalat-wa- Amraz-e- Niswan

Qabalat-wa-Amraz-e-Niswan

Amraz-e- Atfal

Optional

Amraz-e-Atfal

Izterari (Casualty)

Optional

Ilaj bit Tadbeer

D1ry Cupping

optional

Dry Cupping

Wet Cupping

Optional

Wet Cupping

Fasd

Optional

Fasd

Dalak

Optional

Dalak

Riyazat

Optional

Riyazat

Natool

Optional

Natool

Pashowya

Hammam

Optional

Hammam

Taleeq

B.2 Auxiliary Functions (support services for eg – diagnostics) Tashkheesh Amraz Lab.

(Central Laboratory for clinical diagnosis and investigations).

1. There shall be a central laboratory in the hospital complex with proper infrastructure and manpower for carrying out routine, pathological, biochemical and hematological investigations and Unani diagnostic techniques on the patients referred from outdoor and indoor departments of the hospital.

2. There shall be a central Imaging- X-Ray unit in the hospital complex with proper infrastructure and manpower for carrying out routine, imaging investigations on the patients referred from outdoor and indoor departments of the hospital.

Support Services:

1. Accounting

2. Ambulance services

3. Billing

4. Dietary services/ Canteen

5. Essential commodities like water supply, electric supply etc.

6. Finance

7. Financial accounting and auditing

8. Housekeeping and Sanitation

9. Inventory Management

10. Laundry services

11. Medical records

12. Medicine preparation area

13. Medico legal

14. Office Management (Provision should be made for computerized medical

records with anti-virus facilities whereas alternate records should also be

maintained)

15. Personnel Department

16. Pharmacy/ dispensary

17. Purchase

18. Reception,

19. Security services

20. Stores

21. Waste management Housekeeping/ sanitation

C. Physical Facilities C.1 Space requirement

This entails the minimum space required for carrying out the basic functions of the facility which includes:

C.1.1 Minimum area required for establishing the facility,

Type of Health Care Organization

Requirements

If Stand alone building

If part of another building

Clinic

As permitted Development control Floor Space Index, regulations, etc.

under rules, Local

Minimum area should be adequate to accommodate doctors table, consultation chair, two stools/ chairs, examination bed of the size 6 ft X 2.5 ft., privacy screen around examination area while having free mobility.

1to10bed

Local regulations related to building structures, occupancy, etc. will be followed.

11to25

26to50

51 to 100

Teaching Hospitals

C.1.2 Functional space planning of the facility like reception area, waiting area etc 1. Treatmentrooms:

a. Maximum 15 Treatments/Day/Treatment Room.

b. Number of treatments will depend on type & nature of treatments.

2. Consultation & examination room

a. Minimum 10 ft. x 10 ft.

b. Consultation room should be adequate to accommodate:

i. Doctors table,

ii. Consultation chair,

iii. Two stools/ chairs,

iv. Examination bed of the size 6 ft X 2.5 ft.,

v. Privacy screen around examination area while having free mobility

3. Pharmacy/Dispensary specs:

a. The pharmacy should be located in an area conveniently accessible

b. Temperature & humidity to be maintained as per the requirement of the stored medications.

c. The size should be adequate to contain 5 percent of the total clinical visits to the OPD in one session for hospitals more than 50 beds.

d. Pharmacy should have adequate medicine storage and dispensing facility for indoor and outdoor patients.

4. Entrance hall with reception area, enquiry counter, cash counter and record area

a. Preferably 100 sq. ft per 25 beds

5. Waiting area in entire organization

a. Preferably 100 sq. ft per 25 beds i.e. 10% seats of average number of patients visiting daily to hospital

6. Kitchen area: Applicable only if food is cooked in the hospital. Providing food is mandatory for hospitals of size over 100 beds.

a. Kitchen area should be sufficient size to prepare food for inpatients as per diet schedule advised by the physician

b. Kitchen layout and functioning should follow the flow of materials as: Entry-> washed->cutting-> cooking->loadingTo Serve

c. Utensil washing area is separate from the cooking area.

7. Medicine preparation area: Mandatory for hospitals of size over 50 beds.

a. Preparation area should be of minimum 50 sq. ft: only if medications are prepared in the hospital.

8. Medical Stores specs:

a. The medical store may be part of pharmacy or separate and secured.

b. Area should be clean, well ventilated, well lit, without any dampness or fungal growth on walls.

9. RMO Duty Rooms:

a. Minimum 1 room with attached bathroom & WC, per 2 doctors with separate rooms for male & females with separated sleeping facility with ceiling fan, drinking water facility, intercom, mattress, pillows, blankets, bed sheets. Cupboards/ wardrobes.

10.Nursing station/ duty room (Nurses):

a. One nursing station/room per 15 beds.

b. Applicable for clinics only if there is a day care ward.

c. Nursing stations should be spacious enough to accommodate a table, requisite chairs, working platform, medicine racks, a work counter, sinks, dress table, screen, pedal operated trash bins.

d. Station should accommodate all nurses on duty at any time.

11.Clinical laboratory specifications:

a. Laboratory services can be outsourced or can be optional for hospitals up to 100 beds.

b. Laboratory services are mandatory for hospitals above 100 beds for quick diagnosis of blood, urine, etc., a small sample collection room facility shall be provided.

c. Separate Reporting Room for doctors should be there.

12.Radiology section:

a. Role of imaging department should be radio-diagnosis and ultrasound along with hire facilities depending on the bed strength.

b. The department should be located at a place which is accessible to both OPD and wards and also to operation theatre department.

c. The size of the room should depend on the type of instrument installed.

d. It should confirm to AERB requirements.

e. The room should have a sub-waiting area with toilet facility and a change room facility, if required.

f. Film developing and processing (dark room) shall be provided in the department for loading, unloading, developing and processing of X-ray films.

g. Separate Reporting Room for doctors should be provided.

13.Laundry (optional)

a. Laundry services can be outsourced or can be optional.

b. If it is provided in house, it should have necessary facilities for drying, pressing and storage of soiled and cleaned linens.

c. If outsourced, disinfection of linen is carried out by the hospital before handing over the linen to the out-sourced organization.

14.Emergency Room specifications:

a. Emergency room should be spacious enough to accommodate a table, requisite chairs, working platform, medicine racks, a work counter, sinks, dress table, screen, pedal operated trash bins.

b. Station should accommodate all nurses & doctors on duty at any time.

c. Room should allow free movement of wheel chair or trolley.

d. Emergency Room should preferably have different entry than the hospital entry.

e. Access to Emergency Room should have a ramp for wheel chairs and stretchers.

15. House-Keeping:

a. b. c.

Housekeeping services should be made available for effective cleanliness. Housekeeping services can be outsourced.

Designated areas within functional areas for housekeeping materials has to be in hospital more than 30 beds

16.Security Services:

a. There is a designated location for each security staff on duty.

Medical record-room:

b. Medical record-room should be of adequate size as per the load of the documents of the hospital.

c. Tamperproof material and locking facility Cabinets/ cupboards/ Boxes will be used.

d. Fire extinguishers of correct type should be made available nearby all locations.

17.Store rooms:

a. Store room should be lockable & of adequate size with exhaust fan.

b. Area should be clean, well ventilated, well lit, without any dampness or fungal growth on walls.

18. Wards:

a. Treatment areas for male and female patients shall be segregated if managed as wards and there should be privacy for individual patients. Alternatively individual or sharing rooms can be used to segregate patients of different gender.

b. The ward planning will address minimization of the work for the nursing staff and shall provide basic amenities to the patients located within an area or unit.

c. Ward unit will include nursing station, preferably a treatment/ procedure room, nursing store and toilets as per the norms.

d. At the minimum one nursing station per ward of upto 45 beds will be provided.

e. There should be minimum 50 ft area per bed with 7 feet distance between the mid-points of adjoining beds and at least 3 feet distance between the beds and a 8″ distance between the bed and the wall.

f. Width of the door to be at least 4 feet.

g. Permanent, semi-permanent or temporary partition should be present between two beds.

Partitions may be used as and when needed

h. Ward store area with lockable wall or steel cupboard(s).

19. Duty rooms for doctors

a. To accommodate 1 bed of 6 feet X 3 feet and a side table.

b. Separate beds if sharing for same gender.

c. Separate rooms for separate genders will be provided.

20. Duty rooms for nurses:

a. To accommodate 1 bed of 6 feet X 3 feet and a side table.

b. Separate beds if sharing for same gender.

c. Separate rooms for separate genders will be provided.

21.Duty rooms for technicians: (optional but prerequisite with functional casualty)

a. To accommodate 1 bed of 6 feet X 3 feet and a side table.

b. Separate beds if sharing for same gender.

c. Separate rooms for separate genders will be provided.

Needed only when emergency is functioning, Man power for technicians will increase accordingly

22.Dirty utility room:

a. Separate area of minimum 15 sq feet.

24: Regimental Therapy Unit or treatment room:

a. The department is more frequently visited by out-patients and IPD patients but should be located at a place which may be at convenient access to both outdoor and indoor patients with privacy.

b. It should also have separate rooms for cupping, and leeching with a leech bank and other regimens.

C.1.3 Dimensions of the sub areas of the facility, including the flow of the processes which in turn will give a layout of the department /unit.

Specifications of the Regimental Therapy Unit:

1. Room Size: Minimum 10 ft. X 10 ft. (As size of massage table is 7ft X 3 ft. the size of room should be 10ft X 10 ft.)

2. Mandatory if procedures are done.

3. Separate Unit is proposed for male & female with attached toilet and bathroom

4. Optional and depending on work load. If more than 15 procedures are carried out per day, separate rooms should be provided.

Specifications of the Operation Theater/ Minor OT for Fasd (Venesection), cautrization:

OT/ procedure room should have sterile zone of at least 10 ft X 10 ft; Size is exclusive of clean zone, independent enclosure to accommodate equipment & maintaining adequate privacy.

1. OT is mandatory if surgical procedures are provided in any hospital. Waiting area:

a. Adequate number of seats/ chairs with respect to the bed strength and load of the patients will be provided.

b. Separate waiting area for Regimental therapy services is mandatory only in health care units which provide stand-alone Regimental therapy services. Otherwise common waiting areas of the facility can be utilized.

2. Consultation room with examination room: adequate to accommodate Doctors table, consultation chair, two stools/ chairs, examination bed of minimum size of 6 ft. X 2.5 ft., privacy screen around examination area.

3. Sterilization room: adequate to accommodate sterilization equipment & sterilized material.

4. Separate Recovery room for regimental therapy is mandatory only in health care units which provide stand-alone services. Otherwise ward beds of the facility can be utilized.

5. Separate disposal zone for storage of waste as per bio-medical waste management rule

C.1.4 Basic signage

1. A signage within or outside the facility should be made available containing the following information.

2. *All signage meant for patients and visitors shall be bilingual – Local language and Hindi / English.

C.1.4.1Name of the care provider with registration number,

1. Name of organization.

2. Display of Registration under clinical establishment act

C.1.4.2 Fee structure,

1. Display of tariff list at OPD, Emergency etc.

2. Display of citizen charter in OPD and emergency

C.1.4.3Timings of the facility

1. Display of OPD timings with names and respective specializations of consultants in OPD.

C.1.4.4 Services provided

Directional signage at main entrance towards emergency and OPD

1. Directional signage for patients for utilities and conveniences like toilets, drinking water, telephone booths, shops

2. Directional signage within the hospital building for all departments within the building

3. Display of department / area name on the entrance of each area / room / counter

4. Display of hospital layout at various entrances in the hospital

5. Display of hospital’s scope of services at OPD, Emergency and at Campus

entrance

6. Floor Plan With Location Of Departments

7. Plan of Facility

8. usages: departments, OPD & IP room & wards, waiting areas,

C.1.5 Others

1. Display of all radiation hazard signage in radiation areas (if applicable).

2. Display of Biomedical waste segregation at all location where BMW bins are kept

3. Display of danger signage at all electric panels and other dangerous areas

4. Display of General instructions like ‘No Smoking’, ‘Keep Silence’, ‘Use dustbin’, etc. at various patient and visitor areas in the hospital

5. Display of hand–washing techniques compliant with WHO guidelines at all hand wash basins

6. Display of how to use fire extinguisher at all point where fire extinguisher is installed

7. Display of important phone contact numbers of hospital authorities

8. Displays required by regulations like PNDT, Lifts, Fire, etc.

9. Display of Material Safety Data Sheet at all locations where Hazardous Materials are stored

10. Display of patient rights and responsibilities in OPD, emergency and wards

11. Display of safety instructions in areas where any kind of safety hazard may be expected. This includes areas like transformers, Cylinder storage, LPG storage etc.

12.Emergency exit signage (preferably in auto illumination material, like radium)

13. Fire Protection

14. Hazards- electrical, fall, pipe locations, prohibited areas

15. Notice board for general information to staff

16. Notice board in front of all OPD and Wards.

17. Notice board in Operation theatre

18. Routes for all areas

19. Signage for parking. (Signage for ambulance parking shall be separately mentioned)

20. Safety signage will be displays as per the requirements of respective Indian Standards: Ex. Fire Protection Safety Signs IS 12349:1988

C.2 Furniture & Fixtures:

This will entail the details about the furniture and sundry items commensurate to the service delivery requirements.

C.2.1Furniture/Fixture Requirements:

Furniture/Fixture Requirements for Outpatient Department (OPD):

Name of the Equipment

Clinic

Hospital

Clinic

1 to 50 beds

51-100 beds

101- 200 beds

201 and above beds

Room with well-lighted and ventilated and equipped with a chair and a table for doctor

1 per consultation room

X-ray viewer

1 per consultation room

Two chairs for patients & attendants

1 per consultation room

An examination table of 6 ft. X 2.5 ft. With privacy screen

1 per consultation room

Blood pressure apparatus

1 per consultation room

Stethoscope

1 per consultation room

Torch

1 per consultation room

Thermometer

1 per consultation room

Weighing machine

1 per consultation room

Essential diagnostic tools required for examination of patients as per the scope of services offered by the hospital.

As per requirement

Light source which gives light colour and temperature similar to solar light,

Light intensity of at least 500 lux at the point of examination.

As per requirement

Refrigerator if temperature sensitive medication are stored (if required)

1 per consultation room

Computers, (if required)

1 per consultation room

Telephone equipment

As per requirement

Air conditioning

As per requirement

Computers, (if required)

1 per consultation room

51-100 beds

101-200 beds

Name of the Equipment

Adequate wall or steel Cupboards per Ward Arm Board (Adult) Back rest

Bain Marie trolley (stainless steel) 1 per floor

Bed side cabinets

Bed side Screen

Bucket metallic As needed

Ceiling Fans As per requirement

Clock ( 1 per ward) 1 per ward

Containers for kitchen As needed

Doctor’s chair As needed

Doctor’s or Office table As needed

Dressing trolley-1 per floor/ 1 per ward

ward depending on layout

Dust bins in each ward & 1 per ward

consultation room

Duty table for nurses 1 per ward

Emergency resuscitation kit 3 per ward

Enema Set 2 per ward

Fire extinguisher – ABC 1 per ward/ floor based on layout Foot stools 8 25 Fridge 1 Per Area/ Ward

Heavy duty Torch light 1 per ward

Hospital Cots 50 500 Hospital Cots Pediatric 5 50 Hot Water Bags 2 per ward

Hot Water geyser 2 per ward

IV Stands – 2 per 10 beds 10 100

1 to 50 beds 201 and above beds

As needed As needed 1 per floor

1 per 5 patients

1 per ward or full length curtains between the beds

100

300

Infra-Red lamp 3

Intercom System 1 per ward

Kidney Tray 1 per 5 beds 20

Kitchen utensils, Adequate

Massage table of 7ft. x 2.5ft One per procedure room

(wood or fibre)

Medicine trolley 1 per ward

Office chairs 4

Office Table 3

Patient beds with side rails

Patient call Bell System

Patient locker

Patients examination table– 1 – 1 per ward/ floor a per the profile of patients & layout

10 50

20 10

20% of total beds 1 per bed

1 per bed

per ward/ floor a per the profile of patients & layout of facility

of facility

Patients side table

1 per bed

Pediatric cots with railings as per scope of services

as per scope of services

Steel or Wooden cup board

Steel rack

Stool 1Per Bed

Stools revolving – 2 per ward

2 per ward

Stretcher/ Patient trolley – 1 per ward

1 per ward

Urinal Male and Female

100

waiting chairs / benches for patients relatives

50% of the bed strength

Weighing Machine

1 per ward

Wheel chair

2 per 50 beds

Wooden massage bed

One per service room

X-ray viewer

one per ward

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101-200 beds

201 and above beds

Arm chair

One per service room

Examination table

Minimum 1

Focus lamp

Minimum 1 per service room

Foot stool

One per service room

Gas/Stove

One per service room

Glass containers (1 liter capacity) for storing used leeches:

5-10 (for each patient requires separate container and the number may vary according to the number of patients)

Good light source

Minimum 1 per service room

hamox stretchers / Stretchers with wheels

One per service room

Heating facilities

One per service room

Hot water bath

One per service room

IV stands

One per service room

Massage table of 7ft. x 2.5ft (wood or fibre)

One per service room

Mixture/Grinder/Churner

One per service room

OT table / Lithotomy Table with Side Railings

Minimum one

Plastic aprons, gloves and mask

One per service room

Amal tariq (wooden chamber)

One per service room

Revolving stools

Minimum 1 per service room

Stool

One per service room

Sufficient light and ventilation

One per service room

Surgical trolley

Minimum 1

Torch

Minimum 1 per service room

Wheel chairs

One per service room

Pressure cooker (10 litre minimum)

One per (massage)service room

Nutool table with flexible hanging stand

One per (nutool) service room

Tubs for Pashowya and Abzan

One per (nutool) service room

C.2.2 Sundry Articles Requirement

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101-200 beds

201 and above beds

Air conditioners Central A/C for OT

Optional

Minimum 1

Ambulance

Optional

Minimum 1

Ceiling / wall Fans

As needed

Clock

1 per ward

Computer with modem with UPS, printer with internet connection

As needed

Coolers

As needed

Drinking Water purifier

As needed

Emergency lamp

2 Per Area/ Ward

Emergency trauma set

2 per ward

Exhaust Fan

As needed

Fire extinguishers

As needed

Geyser

2 per ward

Refrigerator

1 per ward

Storage Geyser

1 per ward

Tables & Chairs

As needed

Telephone/ cell phone

1 per ward

Tube lights

As needed

Vacuum cleaner

As needed

C.2.3 Others

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101- 200 beds

201 and above beds

Computer with Modem with UPS, Printer with Internet Connection

As needed

Photocopying Machine

As needed

1 per ward

Intercom (10 lines)

As needed

Fax Machine

–

As needed

Telephone

One per organization

Two per organiz ation

Public Address System

–

Covering Indoor and OPD Areas

C. 3 Engineering Services Requirements

This will include the detail information about the basic requirements including

C.3.1Electrical Requirements

1. At least 3 hours backup or generator for critical areas

2. Primary electrical Supply is available as provided by the local utility provider. Lighting back up for at least 1 hour covering all functional areas must be available during the functioning time.

3. Primary electrical Supply as supplied by utility provider. Emergency backup for at least 3 hours backup for electricity & for lighting and critical equipment must be available during the functioning time. Take over time must be less than 30 seconds. Electric supply to lighting will be backed up with UPS/ Inverter/ Battery.

4. The illumination in the hospital is provided as per the prescribed standards.

5. Shadow less lights should be provided in operation theatres and delivery

rooms.

6. Emergency portable light units should be provided in the wards and departments.

C.3.2Plumbing Requirements 1. Number of Wash basins

i. 1 for every 20 persons or part there

ii. Doctor, staff, patients and visitors have an access to wash basin(s) 1 for every 50 persons or part there.

iii. Dirty utility & surgical / procedural hand wash basin will be separate from general use & one each.

Number of Water closets

i. 1 for every 20 beds or part thereof.

ii. Doctor, staff, patients and visitors have an access to wash closet(s) 20 beds or part thereof.

For in-patient department

No. of Wash basins

i. 1 for every 12 beds or part thereof

ii. Doctor, staff, patients and visitors have an access to wash basin(s);

iii. Procedure hand wash basins are separate and located close to procedure area.1 for every 12 beds or part thereof

No. of Water closets

i. 1 for every 6 beds or part thereof

ii. Separate water closets are available for use for outpatient and in-patient areas.

iii. For in-patient areas the water closets are provided in the ratio of 1 per 6 beds and are located close to patient care areas.

b. No. of bathrooms

ii. Minimum1 bathroom per 6 beds/ one for each therapy rooms

c. WC

i. Minimum1 bathroom per 6 beds/ one for each ward rooms

i. Minimum 1 WC per 6 beds/ one for each Male & Female wards

ii. Average size of toilet : 810 mm X 1800mm with grab bars

iii. Minimum 1 WC per 6 beds/ one for each Male & Female wards

iv. At least one wheel chair friendly toilet of dimensions 2200mm X 1800mm must be provided.

C.3.3Civil Requirements

1. Space between 2 rows of beds in a ward should be minimum 5 ft.

2. Distance between 2 beds should be minimum 3.5 ft. if more than one bed is present

3. If clinic has beds then: measured between the facing borders of adjoining beds there shall be at least 3 feet of distance if the beds are mobile and provided with functional wheels and at least 4 feet if beds do not have functional wheels.

4. If there are no beds then this requirement is not applicable.

5. Size of hospital bed should be minimum 6’ x 3’

6. Area per bed should be Minimum 50 sq. ft. / bed

C.3.4 HVAC / AC / Ventilation / Cross Ventilation Requirements

1. Air-conditioning and Room Heating in operation theatre and neo-natal units should be provided.

2. The ventilation in the hospital may be achieved by either natural supply or by mechanical exhaust of air.

3. Cross ventilation/ Mechanical ventilation by fans and or exhausts to achieve comfortable environment without noxious odours.

C.3.5 Others

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

C.4 Public Utilities C.4.1Safe drinking water

1. Round the clock availability of safe drinking water for patients, staff and visitors.

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

C.4.2 Sanitary Requirements

1. Arrangement should be made for round the clock piped water supply along with an overhead water storage tank with pumping and boosting arrangements.

2. Approximately 10000 liters of potable water per day is required for a 100 bedded hospital.

3. Separate provision for firefighting should be available.

4. Water softening plant should be considered where hardness of water is a major problem.

C. 4. 3. Drainage and Sanitation

1. 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.

2. Waste Disposal System: National guidelines on Bio-Medical Waste Management and a Notification of Environment and Forests are at Annexure – I.

D. Equipment /instruments

This includes the type, number, minimum specification & functionality of equipments

required in the facility under the following headings

D.1 Therapeutic equipment

1: Outpatient department (OPD)

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101- 200 beds

201 and above beds

A chair and a table for doctor

1 per consultation room

X-ray viewer

1 per consultation room

stools for Patients

Patients waiting chairs / benches

50% of the bed strengths

An examination table of 6 ft. X 2.5 ft. With privacy screen

1 per consultation room

Blood pressure apparatus

1 per consultation room

Stethoscope

1 per consultation room

Torch

1 per consultation room

Thermometer

1 per consultation room

Weighing machine.

1 per consultation room

Essential diagnostic tools required for examination of patients as per the scope of services offered by the hospital.

As per requirement

Light source which gives light colour and temperature similar to solar light,

Light intensity of at least 500 lux at the point of examination.

As per requirement

2: In-Patient department (IPD) Sn Name of the Equipment

1 Ambu bags

2 Arm Board Adult

3 Autoclave Drums

4 Back rest

5 Bain marie trolley stainless steel 1 per

floor

6 Bed pans: 1 per 5 patients

7 Biomedical waste colour coded bins

8 Cheatle forceps assorted sizes

9 Clock per ward

10 Containers for kitchen

11 Dressing trolley-1 per floor/ ward

depending on layout

12 Dust bins in each ward & consultation

room

13 Emergency resuscitation kit

14 Enema Set

15 Fridge

16 Heavy duty Torch light – 1 per ward

17 Hot Water Bags 2 per ward

18 I V Stands – 2 per 10 beds

19 Infra-Red lamp

20 Instrument tray – minimum 1 per ward

21 Instrument trolley – 1 per ward

22 Intercom System

23 Kidney Trays-1 per 5 beds

24 Massage table of 7ft. x 2.5ft (wood or

fiber)/ Wooden massage bed

25 Medicine trolley

26 Needle cutter – 3 per ward

27 Non mercury Thermometer clinical

28 O2 cylinder with spanner

29 Patients examination table– 1 per ward/

floor a per the profile of patients & layout

of facility

30 Sphygmomanometers-Stand Type 1&

Portable (aneroid or Digital) Type X

31 Stretcher/ Patient trolley

32 Weighing Machine

33 X-ray viewer – one per ward

3: Regimental Therapy Room

1 to 50 beds

51-100 beds

101- 200 beds

201 and above beds

100

Each per floor

1 per ward

As required

1 per ward

1 per floor

As required

1 per ward

2 per ward

2 per 10 beds

minimum 1 per ward

As required

1 per 5 beds

1 per treatment room

minimum 1 per ward

3 per ward

1 per ward

3: Equipments /instruments for Regimental Therapy Room

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101- 200 beds

201 and above beds

Amaltariq (wooden chamber)

Minimum 1

As per requirement: Dressing tray with gloves, bandage cloth, bandages etc.

Adequate

Autoclave equipment for sterilization

Minimum 1

Autoclave/ Sterilizer

Minimum 1

Bedpan (male and female)

As needed

Buckets/Plastic tubs/Basin(with provision of measuring scale)

As needed

Bunsen flame

1 minimum

Clock

1 Per Area/ Ward

Consumables

Adequate

10.

crash cart

Minimum 1

11.

Disposable syringes (5- 10cc, 20-50cc)

As needed

12.

Enema pot

As needed

13.

Examination table

Minimum 1

14.

Focus lamp

Minimum 1

15.

Foley’s Catheter

As needed

16.

Gas/Stove

Minimum 1

17.

Glass containers (1 liter capacity) for storing used leeches:5-10 (for each patient requires separate container and the number may vary according to the number of patients)

Minimum 1

18.

hamox stretchers / Stretchers with wheels

Minimum 1

19.

Hot water bag

Minimum 1

20.

Instruments : Different types of Forceps, Scissors, Needles, Suturing material etc. (as per requirement)

Adequate

21.

IV stands

As needed

22.

Kidney trays

Minimum 1

23.

Knife and scissor1 each

As needed

24. Leeches :As per the requirement, usually 3-5 leeches per patient/ treatment period)

25. Mahjama of different sizes (cupping instruments)

26. Massage table of 7ft. x

2.5ft (wood or fibre)

27. Measuring glasses set

28. Metallic or disposable

insemination cannula

29. Mixture/Grinder/Churner

30. OT instruments

31. OT Table with stand

32. Plastic aprons, gloves and

mask

33. Rubber Catheters without

cracks & without frayed

edges

34. scalpel

35. Small pillows covered with rexin sheet

36. Sphygmomanometer

37. spittoon

38. Sterile apron

39. Sterile cotton

40. Sterile Gauze

41. Sterile gloves

42. sterile urinary catheters

43. Sterilizer or Autoclave

44. Stethoscope

45. stop watch

46. Storage Aquarium for

fresh leeches: 20-25 liters capacity (may be with partitions)

47. Stretchers with wheels

48. Sufficient light and

ventilation

49. Surgical tray

50. Surgical trolley

51. Surgical trolley

52. Thermometer digital

53. Toothed forceps

54. Torch

D.2 Surgical equipment

Optional

As needed

Minimum 1set

As needed

Minimum 1 Minimum 1

Minimum 1 Minimum 1 Minimum 1 As needed

As needed

As required As needed

Minimum 1 Minimum 1 Minimum 1 As per use As per use As per use As per use Minimum 1 Minimum 1 Minimum 1

Optional

Minimum 1 As needed

1 per ward/therapy room Minimum 1 /therapy room

Minimum 1 Minimum 1 Minimum 1

Minimum 1

1: Operation Theater

sn Name of the Equipment

1 Anterior vaginal wall retractor

2 Artery forceps

3 Auto Clave HP Vertical /horizontal (2 bin)

4 Autoclave equipment for

sterilization/Sterilizer

5 Bladder sound (Urethral dilators) of

different sizes

6 Crash Cart with lifesaving drugs and

Resuscitation Kit

7 Cusco’s Speculum

8 Diathermy Machine (Electric Cautery)

9 Disposable syringes (5-10cc)

10 Enema Pot

11 Focus lamp Ordinary

12 Foley’s Catheter

13 Formalin dispenser

14 General Surgical Instrument Set Piles,

Fistula, Fissure, etc

15 Instrument Trays of various Sizes

16 Instrument Trolley

17 IV stands

18 Kidney tray

19 Knife and scissor 1 each

20 L. P. Tray

21 Magill’s forceps (two sizes)

22 Metallic or disposable insemination

cannula

23 Operation table Hydraulic Minor with

stand

24 OT Spot light (Shadowless ceiling fitted/

stand mounted)

25 Oxygen Cylinder

26 Oxygen Mask with Circuit

27 Plastic aprons, gloves and mask

28 Shadowless lamp ceiling type major /

minor

29 Shadowless Lamp stand model

30 Sims speculum in small, medium & large

size

31 Sphygmomanometer

32 Sterile cotton

33 Sterile gloves

Clinic

1 to 50 beds

51- 100 beds

101- 200 beds

201 and above beds

Adequate

Minimum 1

As needed

Minimum 1

As needed

Minimum 1

Adequate

As needed

Adequate

Minimum 1

Adequate

Minimum 1

Adequate

Minimum 1

As needed

Steriliser Small (Instruments)

As needed

Sterilizer big (Instrument)

As needed

Sterilizer Medium (Instrument)

Minimum 1

Stethoscope

Minimum 1

Suction Apparatus – Electrical

Minimum 1

Suturing Set

Minimum 1

Swab holders

Minimum 1

Thermometer

Minimum 1

Tongue depressors

Minimum 1

Toothed forceps

Minimum 1

two long (8 inch)& two short (6 inch) Artery forceps

Minimum 1

two Uterine sound

Minimum 1

Uretheral Dilator Set

Minimum 1

Vaginal Examination set

Minimum 1

Vulsellum

Minimum 1

2: Anesthesia

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101- 200 beds

201 and above beds

Airway female & male

Adequate

Anaesthesia Trolley / Boyle’s Apparatus

Minimum 1 if anesthesia is given

Minimum 1

Anesthetic- laryngoscope magills with four blades

Minimum 2

CO2 cylinder for laparoscope

Minimum 1

Connector set of six for ETT

Minimum 1

Defibrillator/ AED

Minimum 1

Endotracheal tube sets

Minimum 1

Magills forceps (two sizes)

Minimum 1

Mouth prop

Minimum 1

Multi-parameter Monitor

Minimum 1

N2O Cylinder for Boyle’s Apparatus

Minimum 1

O2 cylinder for Boyle’s Apparatus

Minimum 1

Tongue depressors

Adequate

Tubes connecting for ETT

Adequate

D.3 Diagnostic equipment

1: Imaging Equipment

Imaging Equipment

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101- 200 beds

201 and above beds

300 M.A. X-ray machine

Optional

Minimum 1

Ultra Sonogram (Obs & Gyne. department should be having a separate ultra-sound machine of its own)

Optional

Minimum 1

Echocardiogram

Optional

X-ray developing tank

Minimum 1 if X –ray machine exists

Minimum 1

Safe light X-ray dark room

Minimum 1 if X –ray machine exists

Cassettes X-ray

Minimum 1 if X –ray machine exists

Lead apron

Minimum 1 if X –ray machine exists

Intensifying screen X-ray

Minimum 1 if X –ray machine exists

Thyroid shield

Minimum 1 if X –ray machine exists

TLD batches

One per person

Gonadial guard

Minimum 1 if X –ray machine exists

X-ray lobby single

Minimum 1 if X –ray machine exists

2: Laboratory Equipments

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101-200 beds

201 and above beds

Alarm clock 1

Optional

1 Per/ Ward

Automatic cell counter

Optional

Minimum 1

Auto analyzer/ Semi auto analyzer

Optional

Minimum 1

Binocular Microscope

Minimum 1

Chemical Balances

Minimum 1

Counting chamber

Minimum 1

Electric Colorimeter

Minimum 1

Electric centrifuge, table top

Minimum 1

ESR stand with tubes

Minimum 1

Electrolyte analyzer

optional

Minimum 1

Glucometer

1 Per Area/ Ward

Hemoglobinometer

Minimum 1

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101-200 beds

201 and above beds

Hot air oven

As needed

Hot plates

As needed

Lab Incubator

As needed

Laboratory Auto Claves

As needed

Micro pipette of different volumes

As needed

PH meter

As needed

Refrigerator

Minimum 1

Rotor / Shaker

Minimum 1

Simple balances

Minimum 1

Spirit lamp

Minimum 1

TCDC count apparatus

As needed

Test tube holders

As needed

Test tube rack

As needed

Test tube stands

As needed

Timer stop watch

As needed

Water bath

As needed

D.4 Emergency equipment

S No.

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101-200 beds

201 and above beds

Emergency equipment box for first aid & BLSS

Minimum 1

Crash-Cart trolley:1

Optional

Minimum 1

Portable defibrillator:1

Optional

Minimum 1

Disposable syringes

As needed

Ambu Bag:1

Minimum 1

Laryngoscope with cell

Minimum 1

Sealed battery cell

Minimum 1

Endotracheal tubes

As needed

Monitor

As needed

D.5 Sterilizing Equipment

Sterilizing Equipments

Sr. No.

Name of the Equipment

Clinic

1 to 50 beds

51-100 beds

101- 200 beds

201 and above beds

Auto Clave HP Vertical (2 bin)

As needed

Minimum 1

Autoclave equipment (drums or trays) for sterilization/Sterilizer

Adequate

E. Manpower

This includes the Designation, minimum qualification & number of people required in the facility.

E.1Medical practitioners

1. Category: Doctors

2. Minimum Qualifications: Degree/ Post Graduate Degree from recognized university by Central Government or State government of Indian Medicine.

3. Registration: (if applicable): with state or central council of Indian Medicine

4. Trained / skilled: Trained

Strength (The minimum number of staff required as per the function.)

Sr. no.

Doctors BUMS/ MD

Clinic

1 to 50 beds

51-100 beds

101-200 beds

201 and above beds

Hospital Superintendent1

Hakim Specialist (Moalijat)

Hakim Specialist (Jarahat)

Hakim specialist Amraz-e-JIld –wa zohrawia

Hakim specialist Amraz-e-Dimag – wa Asab

Hakim specialist Nafsiyat

Hakim specialist Amraz Ain

Hakim specialist Amraz Uzn Anaf wa Halaq

Hakim Specialist (NiswanwaQabala )

10.

Hakim Specialist (Atfal)

11.

Hakim Specialist (Regimental Therapy)

12.

Hakim Specialist (Preventive Medicine)

13.

Anesthetist

14.

Radiologist DMRE/ MD in concerned subject

15.

Pathologist (visiting/part time/full time)

16.

General Duty Hakims

E.2 Therapists:

1. Category: Therapists:

2. Minimum Qualifications (diploma/degree from recognized university by Central Government or State government of Indian Medicine.)

a. This encompasses certified course in Regimental Therapy from recognized state or central council for Unani medicine

b. On the job training or allied course in Unani medicine.

3. Registration with the concerned council(if applicable): state or central council

of Indian Medicine

4. Trained / skilled: Trained

Strength: Minimum 2 per treatment room; male and female separate; i.e. minimum 2 male technicians or 2 female technicians for a treatment room.

Sr. no

Therapists – Technicians

Clinic

1 to 50 beds

51-100 beds

101-200 beds

201 and above beds

Hammam Female Technician

Hammam Male Technician

Dalak Tecnician Male

Dalak Tecnician Female

Technician for Riyazat

E.3 Paramedics

1. Category:Paramedics

2. Minimum Qualifications (diploma/degree from recognized university by Central Government or State government of Indian Medicine.)

3. Registration with the concerned council(if applicable): state or central council of Indian Medicine

4. Trained / skilled: Trained

Sr. no

Staff

Minimum qualification

Clini c

1 to 50 beds

51-100 beds

101- 200 bedsl

201 and above bedded hospital

Clerk for Billing

12th Standard passed.

Cook

(if food is cooked in- house)

Experience of working in mass kitchen for at least 1 year at senior cook or at in charge level.

As per requirement

Driver (Only in case hospital has its own vehicle for patient or ambulance services)

Driver’s License for the category of vehicle

With State Road Transport Office.

If driving an

As per requirement

ambulance, specific training is required.

ECG Technician

(if ECG services are provided in- house)

1 year experience of taking ECG

–

Electrician

If exists, Diploma in Electrical Engineering

–

Hospital worker (OP/ward +OT)

Eight standard completed

Housekeepin g Staff

Ability to read national or local language

Kitchen Servant

(if food is cooked in- house)

–

As per requirement

Laboratory Attendant (Hospital Worker)

(if lab is in- house)

Ability to read national or local language

10.

Laboratory Technician

(if Lab is in- house)

Qualified Laboratory Technician

11.

Maintenance person

If exists, Diploma in Electrical

Engineering.

12.

Medical Records Officer / Technician

MR Technician/Min imum qualification- 12th Standard passed.

13.

OT Assistant

(if surgical services are provided)

OT TechnicianMini mum qualification- 12th Standard passed.

14.

Peon

Eight standard completed

15.

Pharmacist

(if pharmacy is in-house)

Diploma in Unani Pharmacy (D.Pharma) Bachelor in Unani Pharmacy (B.Pharma) Master in Unani Pharmacy (M.Pharma)- Master of Science in Medicinal Plants (M.Sc Medicinal Plants)- PG Diploma in Unani Drug Standardisation Certificate course

–

16.

Physiotherapist

Qualified PT

17.

Plumber

–

18.

Radiographer

(if Imaging is in-house)

Qualified Radiographer

19.

Sanitary Worker

–

20.

Store keeper/ Manager

Minimum qualification- 12th Standard passed.

21.

Therapy Attendant

Eight standard completed

Minimum 1 and as per requirement

22.

Ward Ayah

Eight standard completed

Minimum 1 per ward/ floor and as per requirement

23.

Ward boy

Eight standard completed

Minimum 1 per ward/ floor and as per requirement

E.4Nurses:

1. Category: Nursing

2. Minimum Qualifications: GNM or BSc or MSc Nursing

3. Registration: State Nursing Council of where hospital is located

4. Trained / skilled: Trained

Nurses to Beds Ratio: 1 per 20 beds

Nursing Staff

Clinic

1 to 50 bedded Hospital

51-100 bedded Hospital

101-200 bedded hospital

201 and Above bedded hospital

Staff Nurse

1 for every 20 beds in IPD and 2 for OPD attendance up to 150 patients and 1 extra each for additional 100 patients.

Matron

–

E.5 Administrative staff: The number would vary as per requirement and may be outsourced.

Administrative staff

Sr. no

Administrative staff

Clinic

1 to 50 bedded Hospital

51-100 bedded Hospital

101-200 bedded hospital

201 and Above bedded hospital

Office Superintendent/ Hospital Administrator

–

Accountant

–

Computer Operator

–

Security Staff*

–

F. Drugs

This segment includes the minimum essential drug which needs to be maintained in the facility.

F.1 Anaesthetics drugs

Category: Anesthetics drugs

Sr. no.

Name of the Drug

Strength

Minimum Quantity

1.1 General Anesthesia (to be given only by a qualified allopathy anesthetist)

Ether,

As per requirement

Halothane

As per requirement

Isoflurane*

As per requirement

Ketamine Hydrochloride Injection

10 mg / ml, 50 mg / ml

As per requirement

Nitrous Oxide

medical grade

As per requirement

Oxygen

medical grade

As per requirement

Injection Thiopentone Sodium

0.5 g, 1 g powder

As per requirement

1.2 Local Anesthesia

Injection Bupivacaine Hydrochloride

0.25%,0.5% 0.5% + 7.5% Glucose

As per requirement

Spray Ethyl Chloride

As per requirement

10.

Injection Lignocaine

Topical Forms 2-5%

As per requirement

11.

Hydrochloride 1-2% Spinal 5% + 7.5% Glucose

As per requirement

12.

Injection Lignocaine Hydrochloride + Adrenaline

1%, 2% +Adrenaline 1:200,000 In vial 1.3

As per requirement

1.3 Preoperative Medication and Sedation for Short Term Procedures

13.

Injection Atropine Sulphate

0.6 mg / ml

As per requirement

14.

Injection Diazepam

5 mg Injection 5 mg / ml

As per requirement

15.

any other medication as decided by the concerned anesthetist

As per requirement

F.2 Emergency drugs

Category: Emergency Drugs

Minimum Quantity

Minimum 10 Ampoules/ Vials

Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials Minimum 10 Ampoules/ Vials

Sr. no.

Name of the Drug

Strength

Inj. Adrenaline

As per I.P.

Inj. Atropine

As per I.P.

Inj. Calcium Carbonate

As per I.P.

Inj. Dopamine

As per I.P.

Inj. Dobutamine

As per I.P.

Inj. Nitroglycerine

As per I.P.

Inj. Sodium Bicarbonate

As per I.P.

Inj. Hydrocortisone

As per I.P.

Inhaler Beclomethasone (250 micro/dose)

As per I.P.

10.

Inhaler Salbutamol (200 micrograms)

As per I.P.

11.

Inj. Frusemide

As per I.P.

12.

Inj. Diazepam/Midazolam

As per I.P.

13.

Inj. Deriphyllin

As per I.P.

14.

Inj. Phenytoin sodium

As per I.P.

15.

Inj. Avil

As per I.P.

16.

Inj. Ondansetrone

As per I.P.

17.

Inj. KCl

As per I.P.

18.

Inj. Lignocaine 2%

As per I.P.

19.

Inj. Amiadarone

As per I.P.

20.

Inj. Magnesium sulphate

As per I.P.

21.

Inj. Mannitol

As per I.P.

22.

Inj. Morphine/Inj. Pethidine

As per I.P.

23.

Inj. Noradrenaline bititrate

As per I.P.

24.

Inj. Fentanyl

As per I.P.

25.

water for Injection

As per I.P.

26.

Inj. Sodium Valporate

As per I.P.

27.

Inj. Voveran

As per I.P.

28.

Inj. Paracetamol

As per I.P.

29.

Mannitol Injection

As per I.P.

30.

Metoprolol Injection

As per I.P.

Minimum 10 Ampoules/ Vials

31.

N/2 saline Injection

As per I.P.

Minimum 10 Ampoules/ Vials

32.

Oxygen Inhalation

As per I.P.

Minimum 10 Ampoules/ Vials

33.

Oxytocin Injection

As per I.P.

Minimum 10 Ampoules/ Vials

F.3 General Drugs:

LIST OF MEDICINES / INSTRUMENTS / EQUIPMENTS /LAB REAGENTS / OTHER CONSUMABLES AND DISPOSABLES

Single Unani Drugs Unani Name

• Abhal

• Afsanteen

• Ajwain

• Amaltas

• Amba Haldi

• Amla

• Anisoon

• Anjbar

• Anjeer

• Aqaqia

• Aqarqarha

• Asabgol

• Asarun

• Asgandh

• Asl-us-Soos

• Atees

• Azaraqi

• Babchi

• Babool

• Badiyan

• Badranjboya

• Bakayin

• Balhchar

• Balela

• Baobarang

• Baqla

• Bazrul Banj

• Bedanjeer

• Bedmushk

• Beej Band

 Beekh Baadiyan

 Beekh Karafs

• Behidana

• Bisbasa

• Bisfayej

• Biskhapra

• Brinjasif

Botanical Name

Juniperus communisLinn.

Artemisia absinthium Linn. Trachyspermum ammi (Linn.) Sprague Cassia fistula Linn.

Curcuma amada Roxb.

Emblica officinalis Gaertn.

Pimpinella anisum Linn.

Polygonum bistorata Linn.

Ficus hispida Linn.f.

Acacia arabica Willd.

Anacyclus pyrethrum DC.

Plantago ovata Forsk.

Ruscus aculeatus Linn.

Withania somnifera (Linn.) Dun. Glycyrrhiza glabra Linn.

Aconitum heterophyllum Wall. ex Royle Strychnos nuxvomica Linn.

Psoralea corylifolia Linn.

Acacia arabica Willd.

Foeniculum vulgare Mill.

Melissa parviflora Benth.

Melia azedarach Linn.

Narbostachys jatamansi DC. Terminalia bellirica (Gaertn.) Roxb. Embelia ribes Burm. f.

Mentha longifolia (Linn.) Huds. Hyoscyamus niger Linn.

Ricinus communis Linn.

Salix caprea Linn.

Rumex maritimus

Foeniculum vulgare Mill

Apium graveolens

Cydonia oblonga Mill.

Myristica fragrans Houtt.

Polyjpodium vulgare Linn.

Trianthema portulacastrum Linn. Achillea millefoliumLinn.

• Chaksu

• Chiraita

• Chobchini

• Darchini

• Darunj-e-Aqrabi • Dhatura

• Enabus Saleb

• Filfil Daraz

• Filfil Siyah

• Gaozaban

• Ghariqoon

• Gheekawar

• Ghongchi Sufaid • Gilo

• Gular

• Gul-e-Babuna

• Gul-e-Banafsha

• Gul-e-Gurhal

• Gul-e-Madar

• Gul-e-Surkh

• Gul-e-Tesu

• Gulnar Farsi

• Gurmar Buti

• Halelah

• Halyun

• Hanzal

• Heel Kalan

• Heel Khurd

• Heeng

• Hina

• Inderjau Shireen • Inderjau Talkh

• Irsa

• Izhkhar

• Kahu

• Kaifal

• Kali Ziri

• Kamila

• Karanjwa

• Kateera

• Kattha

• Khatmi

• Khulanjan

• Khurfa

• Kishneez Khushk • Kulthi

• Madar

• Majeeth

• Marorphali

Cassia absus Linn.

Swertia chirayita (Roxb. ex Flem.) Karst.

Smilax china Linn.

Cinnamomum zeylanicum Blume

Dornoicum hookeri

Datura innoxia Mill.

Solanum nigram Linn.

Piper longum Linn.

Piper nigrum Linn.

Onosma bracteatum Wall.

Agaricusalba Linn.

Aloe barbadensis Mill.

Abrus precatorius Linn.

Tinospora cordifolia Miers

Ficus racemosa Linn.

Matricaria chamomilla Linn.

Viola odorata Linn.

Hibiscus rosa-sinensis Linn.

Calotropis gigantea (Linn.) Ait. f.

Rosa damascena Mill.

Butea monosperma (Lam.)

Punica granatum Linn.

Cephaelis ipecacuanha (Brot.) A. Rich.

Terminalia chebula Retz.

Asparagus officinalis Linn.

Citrulluscolocynthis (Linn.) Schrad.

Amomum subulatum Roxb.

Elettaria cardamomum (Linn.) Maton

Ferula foetida regel

Lawsonia inermis Linn./Jasminum sambac (Linn.) Ait. Wrightia tinctoria (Roxb.) R. Br.

Holarrhena antidysenterica (Roxb. ex Flem.) Wall. ex DC. Iris ensata Thunb.

Cymbopogon jawarancusa (Jones) Schult.

Lactuca sativa Linn.

Myrica esculenta Buch.-Ham. ex D. Don Syn.: M. nagi Thunb. Centratherum anthelminticum (Linn.) Kuntze

Mallotus phillipensis Muell.-Arg.

Caesalpinia bonducella Flem.

Cochlospermum religiosum (Linn.) Alston.

Acacia catechu Willd.

Althaea officinalis Linn.

Alpinia galanga (Linn.)Willd.

Portulaca oleracea Linn.

Coriandrum sativum Linn.

Dolichos biflorus Linn.

Calotropis gigantea (Linn.) Ait. f.

Rubia cordifolia Linn.

Helicteres isora Linn.

• Methi

• Mochras

• Mulethi

• Mundi

• Murmakki

• Musli Siyah

• Musli Sufaid

• Nana

• Narkachoor

• Neem

• Nilofer

• Parsioshan

• Podina

• Post Bekh-e- Madar • Pumbadana

• Rasaut

• Rewand Chini

• SaadKoofi

• Salab

• Sanna Makki

• Sarphokha

• Shahtara

• Shalgham

• Shitraj

• Sudab

• Suranjan Shireen

 Sipistaan

 Tirphala

 Tuhkme Khatmi

• Talmakhana

• Tamar Hindi

• Tukhm-e-Kasni

• Tukhm-e-Kasoos

• Tulsi

• Turbud

• Ustukhuddus

• Zanjabeel

• Zaranbad

• Zarawand indica

• Zoofa

Compound Unani Drugs

• Araq-e-Badiyan

• Araq-e-Gaozaban

• Araq-e-Gulab

• Araq-e-Kasni

• Araq-e-Mako

• Araq-e-Mundi

Trigonella foenum-graecum Linn. Bombax malabaricum DC. Glycyrrhiza glabra Linn. Sphaeranthus indicus Linn. Commiphora myrrha (Nees) Engl. Curculigo orchioides Gaertn. Chlorophytum arundinaceum Bak. Mentha arvensis Linn.

Zingiber zerumbet Rosc ex Smith Azadirachta indica A. Juss. Nymphaea alba Linn.

Adiantum capillus-venerisLinn. Mentha arvensisLinn.

Calotropis gigantea (Linn) R.Br.ex Ait. Gosypyum herbacum Linn.

Berberis aristata DC.

Rheum officinale Baill.

Cyperus rotundus Linn.

Orchis latifolia Linn.

Cassia angustifoliaVahl Tephrosiapurpurea(Linn.) Pers. Fumaria indica Pugsley Brassica rapa Linn.

Plumbago zeylanica Linn. Ruta graveolens Linn. Colchicum luteumBak. Cordia latifolia

Embilica officinalis,Terminalia chebula,Terminalia beleria Althaea officinalis

Asteracantha auriculata Nees.

Tamarindus indica Linn.

Cichorium intybus Linn.

Cuscuta reflexa Roxb.

Ocimum sanctum Linn.

Operculina turpethum (Linn.) S. Manso Lavandula stoechas Linn.

Zingiber officinale Roscoe Curcuma zedoaria (Christm.) Rosc. Aristolochia indica Linn. HyssopusofficinalisLinn.

• Araq-e-Nana  Araq e Zeera

• Habb-e-Dabba Atfal

• Habb-e-Hilteet

• Habb-e-Kabid Naushadri

• Habb-e-Kibreet

• Habb-e-Mudir

• Habbe-e-Papita (Desi)

• Habb-e-Rasnt

• Habb-e-Shifa

 Habb e rewand

 Habb e zaranbad

 Habb e Gule Aakh

• Habb-e-Suranjan

• Itrifal-e-Kishneezi

Itrifal Mundi

• Itrifal-e-Mulaiyin

• Itrifal-e-Ustukhuddus

• Itrifal-e-Zamani

• Jawarish-e-Amla Sada

• Jawarish-e-Kamooni

• Jawarish-e-Zanjabeel

 Joshand e Munzije balgham

 Joshand e Sauda

 Joshand e Safra

 Joshand e Musaffi

 Joshand e Mudir Haiz

 Joshand e Zeequn Nafs

o Joshand e Mushil

• Khamira-e-Gaozaban Sada

• Khamira-e-Sandal Sada

• Kushta-e-Faulad

• Kushta-e-Gaodanti

• Kushta-e-Hajr-ul-Yahud

o Laaoq e Sapistan o Laaoq e Kataan

• Majoon-e-Dabeed-ul-Ward

• Majoon-e-Falasifa

• Majoon-e-Najah

o Majoon-e Ushba

o Majoon-e Halela

o Majoon-e Mocharas o Majoon-e Suparipak

• Majoon-e-Seer Alwi Khani

• Majoon-e-Suranjan

 Marham e Dakhliyoon

 Marham e Kafoor

 Marham e Raal

 Marham e Safeid

 Nuqoo Nazla

 Qurs Alkali

 Qurs deedan

 Qurs Jiryaan

 Qurs Kushtae Faulaad

 Qurs Kushtae Sadaf

 Qurs Mulayyan

 Qurs Muhazzil

 Qurs Zarishk

 Qurs Ziabetees sada

 Qurs Ziabatees khas

• Raughan-e-Babuna Sada

• Raughan-e-Banafsha

• Raughan-e-Bedanjeer

 Raughan-e- Gul

 Raughan-e- Hindi

 Raughan-e- Haft barg

 Raughan-e- Kamela

 Raughan-e- Neem

• Sharbat-e-Anjabar

 Sharbat-e Aalobalu

 Sharbat-e Bazoori

 Sharbat-e Unnab

 Sharbat-e Zanjabeel

• Sharbat-e-Banafsha

• Sharbat-e-Deenar

• Sharbat-e-Ejaz

• Sharbat-e-Sadar

• Sikanjabeen Buzoori Motadil

• Sufoof-e-Chutki

• Sufoof-e-Namak-e-Shaikh-ur-Raees

 Sufoof-e-Bars

 Sufoof-e-Beejband Khas

 Sufoof-e-Dawae Pechish

 Sufoof-e-Mullian

 Sufoof-e-Sailaan

• Tiryaq-e-Arba

• Tiryaq-e-Nazla

• Banadiq-ul-Buzoor

• Dawa-ul-Kurkum

• Dayaqooza

• Habb-e-Azaraqi

 Habb-e Bawaseer

 Habb-e Kabid naushadri

 Habb-e Muqil

 Habb-e Musaffi khoon

 Habb-e Rasout

 Habb-e Shifa

 Habb-e Tinkar

• Habb-e-Bohat-us-Saut Haad

• Habb-e-Ghafis

• Habb-e-Hindi Mohallil

• Habb-e-Hindi Sual

• Habb-e-Hindi Zeeqi

• Habb-e-Iyarij

• Habb-e-Momyaee Sada

• Habb-e-Muqil

• Itrifal-e-Deedan

• Jawarish-e-Barshasa

• Jawarish-e-Kundur

• Jawarish-e-Pudina

• Khamira-e-Banafsha

• Zimad-e-Sumbul-ut-teeb

• Zimad-e-Tehal

• Zimad-e-Waram-e-Pistan

• Zimad-e-Waram-e-Unsayain Muzmin

 Zimad-e-Muhasa

 Zimad-e-Massa

 Zimad-e-Nana

• Zuroor-e-Qula Abyaz  Zuroor zaj

G. Consumables

This includes the minimum quantity of the commonly used consumables in the facility which should be made available.

G.1 Surgical

S. no.

Surgical Consumables

Bandage rolled

caps & mask

Catgut Chromic a)1 No., 2 No., 1-0 No, 2-0 N0, 8-0

Clinical thermometer

Developer

Draw sheets

ECG Paper Roll

Ether Anesthetic 500ml

Fixer

10.

Gown

11.

Halothane

12.

HIV Kits if necessary

13.

Hypodermic Needle (Pkt of 10 needle) No.19, 20, 21, 22, 23, 24, 25, 26

14.

Indicator tape for sterilization by pressure autoclave

15. Isopropyl Alcohol swab

16. IV Cannula

17. Leg drape

18. Mackintosh

19. Mask

20. Non Sterile Surgical rubber gloves

21. Plastic aprons

22. Prolene

23.

24.

25. Shaving blade –packet of 5

26. Small and large plastic bottle for keeping his to histo-pathological samples

27. Sterile sheets

28. Sterile disposable syringes

29. Sterile Dressing pads

30. Sterile Infusion sets(Plastic)

31. Sterile Surgical rubber gloves

32. Surgical Disposable

33. Surgical Gloves a)6 “, 6.1/2″, 7″, 7.5″

34. Surgical marking pens/permanent marker ink pen

35. Sutupak 1,1/0,2,2/0

36.

37. Tongue depressor

38. Ultrasound scan film

39. Unani Oral Rehydration powder

40. Vicryl No.1

41. X Ray film 50 film packet(in Pkt) size, 6.1/2×8.1/2″, 8″x10″, 10″x12′, 12″x15″

G.2 Dressing Material

Rubber Mackintosch Sheet in meter

Scalp vein sets no a)19, 20, 21, 22, 23, 24, 25, 26

Syringes 2ml,5ml,10ml, 20ml

S. no

Dressing Material

Absorbent cotton I.P 500gm Net

Adhesive plaster 7.5cm x 5mtr

Adhesive tape

Antiseptic cream

Antiseptic solution

Bandage cloth(100cmx20mm)

Bandages

Pad and Rolls

Marham Hinna

10.

Marham Gulabi

11.

Rolled Bandage a)6cm,10cm,15cm

12.

Sterile & non sterile Gloves of different sizes

13.

Sterile cotton, gamjee pads, gauze pieces

14.

Surgical Gauze (50cmx18m)

15.

Suture removal

G.3Disinfectants: As applicable in adequate quantity

S. no

Disinfectants

Hypochlorite 4%-6%

Ortho-phthalaldehyde (OPA)

70% ethanol plus10ppm Bitrex

Formaldehyde solutions (1%–2%)

Glutaraldehyde

Hydrogen peroxide

Quaternary ammonium compounds

Phenolic germicides

G.4Tubing

S. no

Tubing

Connecting tubing’s for endotracheal suction

Connecting tubing’s for oxygen delivery

Oxygen catheters

Oxygen masks

Suction catheters

Foley catheters

G.5Linen

Linen

Clinic

1 to 50 beds

51 to 100 beds

101 to 200 beds

201 and above beds

1.Abdominal sheets for OT

–

2.Abdominal sheets for OT

–

3.Apron for cook

–

As per requirement

4.Bed sheets

–

200

300

400

500

5.Bed spreads

–

300

400

500

6.Blankets

–

one per bed

7.Curtain cloth windows and doors

As per requirement

8.Doctor’s overcoat

one per doctor per year

9.Draw sheet for wards & OT

Two per bed

10H. ospital worker OT coat

one per worker per year

11L.eggings

as per patient load

12M. ackin tosh sheet (in meters)

one per bed

13M. ats (Nylon)

one per bed

14M. attress (foam) adults

one per bed

15P.aediatric Mattress

one per bed

1 6P . a t i e n t h o u s e c o a t (for female)

Two per bed

1 7P . a t i e n t s p a j a m a (for male) shirts

Two per bed

18to.wels

Two per bed

19P.ereneal sheets for OT

as per patient load

20P.illow covers

Two per bed

21P.illows

Two per bed

22T.able cloth

adequate quantity

23U.niform / Apron

As per requirement

G.6 Stationery

Item

Consents Forms

Continuation Sheets for IPD

Continuation sheets for OPD

Death Certificate Books

Birth certificate book

Diet Cards

Diet Sheets

Discharge cards

Gynecological and Obst. Case sheets

10.

ANC Cards/book lets

11.

Immunization / Vaccination cards

12.

Indoor Admission Form & Case Sheets

13.

Intake Output Charts

14.

Medical Case Sheets

15.

Medico-Legal Forms

16.

Nursing Monitoring Forms

17.

OPD Forms

18.

Pathological Books

19.

Requisition forms for investigations

20.

Registers

21.

Registration Card

22.

Sentinel Event Form

23.

Supplementary Sheets

24.

Surgical Case Sheets

25.

Temperature and BP Charts

26.

Treatment Cards

27.

White Papers

28.

X-ray Forms

G.7 Adhesives and gels: NA G.8 Other: NA

H. Licenses

This includes the minimum statutory compliance applicable as per the central or state government along with licensing body.

Sr. no.

Name of the Act

Department/Area

Licensing body

Registration under Shops and Establishment Act

Organization

Jurisdictional Authorities like Panchayat/ Nagarpalika/ Mahanagarpalika/ Municipality/ Municipal Corporation

Registration under Clinical Establishment Act

Organization

Jurisdictional Authorities like Panchayat/ Nagarpalika/ Mahanagarpalika/ Municipality/ Municipal Corporation

AERB clearances for CT/ MRI/ X ray & Radiation

Imaging

Atomic Energy Regulatory Board

Agreement for Common Biomedical Waste Collection, Transportation, Treatment, Storage and Disposal Facility

Organization

Local Pollution Control Board

Registration under Air (prevention and control of pollution) Act, 1981.

Organization

Local Pollution Control Board

Approval of Radiation Safety Officer

Imaging

Atomic Energy Regulatory Board

Boiler license under Indian Boiler Act, 1923

Boiler

Concerned regulatory Body

Building Permit (From the Municipality).

To be obtained from

Jurisdictional Revenue Authorities like Panchayat/ Nagarpalika/ Mahanagarpalika/ Municipality/ Municipal Corporation

Certificate for Narcotics & Psychotropic Substances

Pharmacy and / Hospital

Drug Controller

10.

Certificate of Registration under society act 1860

Organization

Registrar of societies/ Charity Commissioners office

11.

Certificate u/s 80-G of IT Act

Organization

If applicable.

12.

Class clearance certificate issued to manufacturer/ importer of mobile X ray equipment

Imaging

AERB Class Clearance issued to Manufacturer/ dealer of imaging equipment

13.

Commissioning approval of Linear Accelerator

Radiation Therapy

AERB

14.

ESIS registration in case of >20 employees

Organization

Employee State Insurance Company

15.

Excise permit to store Spirit.

Organization

Excise department

16.

Generator Exhaust air Quality Report

Generator

Authorized Air Testing Laboratory

17.

License to sale or distribute drugs Form 20, 21, 21C

Pharmacy

FDA

18.

License for lift

Lift

Mobile Electric Vehicles Department

19.

License to play music for public use

Organization

Indian

20.

No objection certificate from the Chief Fire Officer.

Organization

Fire Department

21.

Obtaining clearances for weighing equipments in all the hospital units under The Standards of Weights and

Weights and measures

Department of Weights and Measures

Measures Act, 1976.

22.

Occupation Certificate

To be obtained from

Jurisdictional Revenue Authorities like Panchayat/ Nagarpalika/ Mahanagarpalika/ Municipality/ Municipal Corporation

23.

PC PNDT Act, 1996.

Sonography

Health Department of Regulatory Body assigned with the responsibility

24.

Registration of births and deaths Act, 1969.

Organization

Health Department of Regulatory Body assigned with the responsibility

25.

SMPV License for Storage of Liquid Oxygen, Form III (License to compressed gas in pressure vessel or vessels)

Medical Gases in Pressurized Vessels

Licensing Authority

26.

TAN Number

Organization

Income Tax Department

27.

PAN Number

Organization

Income Tax Department

28.

Vehicle Registration certificates for Ambulance

Ambulance and Vehicles owned by the organization

Road Traffic Authority

29.

Water Prevention and control of pollution Act

Organization

Pollution Control Board

I. Basic Processes

I.1 Registration (This will help in developing a database at State / Central level).

1. Name,

2. Age,

3. Gender ,

4. Socioeconomic status

5. Address with PIN code,

6. Marital Status,

7. Contact Number,

8. Type of Diet (Veg, Non-veg),

9. CR/OP/ IP Number,

10. Date & Time of visit for OP/ admission for IP,

11. Diagnosis

12. Name of Treating Doctor

I.2 Assessment

1. Primary Complaint of the patient:

2. History of Primary Complaint:

3. History of Medication:

4. History of Implants/ Pacemaker/ Surgery:

5. Past History

6. History of allergies

7. Diet and Lifestyle History

8. Family History

9. Personal History

10. General Examination

11. Systemic Examination

12. Physical Examination

13. Pain Scoring

14. Nutritional Assessment

15. Mizaj assessment

16. Diagnosis Provisional / Final

17. Preventive Aspects

18. Plan of Care

19. Treatment

I.3 Infection Control

1. Cleaning: to be done with defined solution with dilution as advised by the manufacturer. Defined schedule with full cleaning at least once a day.

2. Disinfectants: Defined solution with dilution as advised by the manufacturer. Defined schedule with full cleaning at least once a day.

3. Advisable to have designated Infection Control Officer for hospital more than 50 beds.

4. Advisable to have designated Infection Control Committee for hospital more than 50 beds.

5. Infection control activities should be monitoring by define method & schedule.

I.4Safety considerations

(Surgical safety, infection control, biomedical waste, first aid & basic life support, disaster preparedness)

1. Following physical safety aspects shall be taken care in the hospital

1. AERB safety rules shall be followed in Radiology and other radiation areas.

2. All areas where a physical hazards may occur, like near DG set, transformer, Cylinder storage, electric panels, steep slope etc. shall be provided with safety signage and safety instructions

3. All balconies and opening on higher floors shall have grills

4. All bottles containing acids or alkalis shall be stored on cupboards at height below the shoulder level to prevent them from falling while taking out. It shall never be stored on height above the head level

5. All electric panels shall be enclosed in insulated and nonflammable box and shall be kept locked

6. All entry doors, windows and furniture shall be maintained in good maintained condition

7. All equipments, furniture awaiting condemnation shall be stored in separate condemnation area

8. All stretchers and wheelchairs shall have safety belts for fastening the patient

9. Anti-skid mats shall be placed on entrance of bathrooms

10. Boundary wall of the hospital’s campus shall be of sufficient height with metal fencing on top. Entire boundary wall shall be kept in intact condition

11. Corridors and passages shall not be blocked by chairs, tables or equipments

12. Displays of ‘floor is wet’ or ‘under repair’ or similar precautions in required areas and time shall be available with the hospital

13. Doors height shall be at least of 8 feet

14. Electric rooms shall not be used as store room or for any other purpose

15. Emergency exit routes shall be kept clear all the times

16. Hospitals ground shall be properly maintained. There shall be no openings, or pits in the ground. The surfaces shall be kept even

17. Lab shall be provided with safety equipments like eye wash cups

18. Material safety data sheet shall be available for all hazardous materials

19. No door shall open towards public areas like crowded lobby etc. (the door shall preferably open towards the inside of room)

20.No inflammable materials like, diesel, LPG, acids etc. shall be stored near electrical panel

21.Personal protective gears shall be available everywhere and in adequate quantity. These include gears like, gloves, masks, gowns, boots, caps, goggles etc. Earplugs shall be provided to staff in areas where there is continuous noise, like AC plant.

22. Protection from stray dogs and other animals shall be ensured in the hospital campus

23. Rubber matting shall be placed on the floors below electric panels

24. Seepage shall not be allowed in areas where electric panels or wires are present

25. Terrace should have side walls of at least 4 feet height

26. The beds shall have provision for providing side guardrails.

27.There should be no losing of electrical wiring. All electrical wiring shall be concealed and kept intact

2. Surgical safety

1. There are two independent identifiers for each patient. Name of patient with some other independent identifier.

2. Identification bands for patients should be considered in cases where patient cannot be relied upon to give correct information on his own identity. E.g. pediatric, disoriented, altered consciousness, etc.

3. Use of surgical safety check list based on WHO Criteria is used consistently for each procedure and surgical intervention. The Checklist should divide the operation into three phases, each corresponding to a specific time period in the normal flow of a procedure

a. the period before induction of anesthesia,

b. the period after induction and before surgical incision

c. The period during or immediately after wound closure but before removing the patient from the operating room.

4. In each phase the checklist task must be completed before proceeding forward.

3. Infectioncontrol:

1. Biological safety assessment is done for all areas of patient care and risks defined for the same.

a. Needle Stick Injury and related Transmissions

b. Patient to staff, patient to patient and staff to patient risk of transmission of diseases is addressed and preventive measures are instituted.

c. Procedure site and surgical site infections are monitored.

2. Preventive measures and remedies for correction are kept available wherever such risk exists.

3. Hand washing practices as per WHO recommended criteria are followed and monitored regularly.

4. Facility and consumables for hand washing are available tat convenient locations in the healthcare facility.

5. Adequate equipment and disposables related to personal safety for infection transmission are available to staff and patients in the organization. E.g. equipment like fogging machine, UV sterilizers, Insect Killer Machines and consumables such as Gloves, hand washing materials/ hand gels, surgical Masks, N95 Masks, industrial gloves, etc.

4. Biomedical waste:

1. Biomedical waste is collected, segregated, packed, transported and disposed according to the regulatory guidelines.

2. Biological Waste Management is monitored on regular basis.

3. Biomedical waste disposal is a part of infection control activities.

5. First aid & basic life support

1. At all times there is a staff member who is adequately qualified and is trained in giving at least Basic Life Support System.

2. Adequate qualifications will include qualified nurse or doctor from any specialization who has undergone training on Basic Life Support.

3. There will be a full resuscitation set maintained for use exclusively during such events, irrespective of existence of similar equipment anywhere else in the hospital.

6. Disaster preparedness: Mandatory for all hospitals of all sizes.

1. Healthcare organization must identify various possible disasters and prepare for the same by stocking necessary consumables, training adequate staff and conducting drills regularly.

2. Keeping equipment in a state of readiness for use during such events.

3. Separate stock is maintained as per the risk perceived for the anticipated disorder(s).

4. Keeping a back-up of consumables at all times in usable condition for use during disaster.

5. Personnel are trained for disaster management

6. Disaster drills are carried out at least once in six months for various disaster anticipated.

7. Anticipated list of disasters can include and is not restricted to any of:

a. Fire

b. Terrorist attack

c. Invasion of swarms of insects and pests.

d. Earthquake.

e. Civil disorders effecting the Organization.

f. Sudden failure of supply of electricity. (Disaster)

I.5 Clinical Records (including consents)

Sr. no

Records

OPD/ IPD Records

Treatment Orders

Medication Records

Procedure Records

Nursing Monitoring Records

Nursing Treatment Records

Reports of investigations

Consents: General Consent at admission, Procedure consents

I.6 Discharge

1. Discharge Summary should have following details:

a. Primary data of Name, Gender, Age, Address with PIN code, Marital Status, Contact Number, Type of Diet (Veg, Non-veg), CR/OP/ IP Number, Date of visit for OP/ admission for IP, Treating Doctor

b. Primary Complaint of the patient

c. History of Primary Complaint:

d. History of allergies

e. Salient Examination Findings

f. Investigations carried out

g. Pain Relief Advice

h. Nutritional Advice

i. Diagnosis – Final

j. Preventive Aspects

k. Treatment Given

l. Details of procedures performed

m. Treatment advised

n. Contact number in case of emergency

MINIMUM STANDARDS FOR

CLINICAL ESTABLISHMENTS OF

SIDDHA

100

MINIMUM STANDARDS FOR SIDDHA CLINICAL ESTABLISHMENTS

Categories of Clinical Establishments

I. Clinic

II. Dispensary

III. Therapy Centre IV. Hospital

i. Minimum 10 Beds ii. 11 to 25 Beds

iii. 26 to 50 Beds

iv. 51 to 100 Beds

V. Teaching Hospital

101

CONTENTS

SN A.

A.1 A.2 B. C. D. E.1

F.1 F.1.1 F.1.2 F.1.3

F.1.4 F.1.5 F.2 F.2.2 F.2.3

F.3 F.3.1 F.3.2 F.3.3 F.3.4 F.3.5 F.4 F.4.1 F.4.2

G.1

G.2 G.3

H.1 H.2 H.3 H.4 H.5 H.6

TITLE PAGE

Introduction

Aim 104 Scope 105

Clinics, Dispensaries and Therapy Centres 106 Hospital 112 Core functions (Clinical services) 112

Auxiliary Functions (support services) 116

Physical Facilities

Space requirement 117 Minimum area 117 Functional space 118 Dimensions of the sub areas 121

Basic signage 122 Others 122 Furniture & Fixtures 123 Sundry Articles 128 Others 129

Engineering Services Requirements 129 Electrical Requirements 129

Plumbing Requirements 129 Civil Requirements 130 HVAC / AC / Ventilation / Cross Ventilation Requirements 130

Others* 130 Public Utilities 130 Potable drinking water 130 Sanitary Requirements 130

Equipment /instruments

Therapeutic equipment 131

Surgical equipment 135 Diagnostic equipment 137

Manpower

Medical practitioners 139

Therapists 141 Paramedics 141 Nurses 143

Administrative staff 143 Miscellaneous staff 144

Drugs 145

Consumables

102

J.1

Surgical

145

J.2

Dressing Material

146

J.3

Disinfectants

147

J.4

Tubing

147

J.5

Linen

148

J.6

Stationery

149

J.7

Consumables for Karanool

149

J.8

Laboratory

150

J.9

Leech Therapy

151

J.10

Suttigai

151

Licenses

152

Basic Processes

154

L.1

Registration

154

L.2

Assessment

154

L.3

Infection Control

154

L.4

Safety considerations

155

M.1

Clinical Treatment Records

157

M.2

Discharge

158

Teaching Hospitals

159

References

160

Abbreviations

160

103

In pursuance of notification of Clinical Establishments (Registration and Regulation) Act, 2010 on 28th February 2012, National Council for Clinical Establishments has been constituted and notified on 20th March 2012. One of the mandate for the council is to develop minimum standards of clinical establishments for achieving the objectives of the act.

Defining minimum standards for different types of clinical establishments would facilitate implementation of Clinical Establishments, Act 2010. The registration and regulation of clinical establishments will ensure the delivery of assured quality in health services. The enforcement of regulation measure for clinical establishments raises the level of confidence and faith in Siddha Medicine. There has been misleading advertisements by fake establishments which needs to be curbed by introducing the transparent system of control over them. It would also help other related service agencies like health Insurance and CGHS for empanelment and enlisting their service through them.

The standards thus framed will provide clear, unambiguous minimum requirement for different category of clinical establishments. There are no exclusions. They are dependent on the basic functions of the clinic/hospital/provider. All sections mentioned are Yes and include both structure and basic processes.

A.1.1. Aim

To develop minimum standards for clinical establishments of Siddha Medicine for Clinics, Dispensaries, Therapy Centres, Hospitals and Teaching Hospitals

A.1.2. Methodology

Department of AYUSH letter vide F.No.Z.25023/12/2013-DCC (AYUSH) dated 10-10-13 has directed to develop a draft standard for each category of AYUSH establishments. Accordingly, a meeting was convened with participation of all faculty members to appraise the background and need for preparing minimum standards.

Director has apprised about the notification issued for registration of clinical establishments and need for development of minimum standards of clinical establishments of various categories. Then, the survey report of Indian Medical Association has been examined through LCD projector to understand the prevailing standards of clinical establishments. The draft minimum standard of clinical establishments sent by Department of AYUSH was also examined to learn about the template and structure of the guidelines. The faculty members were sensitized regarding the process of clinical establishments of Siddha Medicines.

A.1.3. Formation of Core Committee

1. A core committee comprising 3 to 4 members for various sections of the report were formed. The identified sections were Introduction, Functions, Physical facilities, Equipments, Manpower, Drugs, Consumables, Licences, Basic Process and Bibliography. A member was given the responsibility of co-ordinating with all committee members

2. All the committee were given the copy of draft minimum standards prepared for Ayurveda and IMA report and directed to study the report for understanding the template and contents of report

104

3. After 2 days, the committee for “Introduction” section presented their views on different categories of Clinical establishments. After the deliberation and decided to list – Clinic, Minimum 10 Beds, 11-25, 26-50, 51-100, 101-200 > 200 and above considering the NABH.

4. The committee meant for “Functions” was asked to prepare the section B-Function within a week time and present in the next meeting considering the different categories of clinical establishments

5. The committee meant for “Functions” presented their report on B.1. Core functions (Clinical services) for OPD and IPD followed by Auxiliary functions

6. All the faculty members deliberated in detail about the identified speciality areas under ‘B.1.Core Functions” referring speciality education (Doctor of Medicine / Post Graduate Diploma) courses offered under CCIM regulations

7. With inputs from faculty members, the core functions were modified and a copy of draft was given to all members. All the committee members were directed to refer the functions and prepare the standards for each sections assigned to them for submission after a week time.

8. Then, a meeting held to deliberate on the draft report prepared by the respective committee. Each committee has presented their sections and discussed

A.1.4. Meeting in Department of AYUSH

1. Finally the draft report has been compiled and presented at the meeting convened by Dr.D.C.Katoch, Convenor on 13-11-2013 in Department of AYUSH

2. The outcome of the meeting was, categorisation of clinical establishments 1) Unambiguous understanding and intent for development of standards

2) Categorisation of Hospitals

3) Conceptualisation of different sections of minimum standards

3. In the light of outcome of the meeting in Department of AYUSH, a draft standard prepared

4. Review comments obtained from selected private Siddha practitioners

A letter vide No.K.25023/12/2013-DCC (AYUSH) dated 7-2-2014 from Department of AYUSH conveyed the classification of AYUSH Clinical Establishments with approval of Secretary (AYUSH) and directed to revise the standards of AYUSH clinical establishments. Then a meeting of selected faculty members under the Chairmanship of Director conducted on 13-2-2014 for preparing the documents.

A.2 Scope

This includes the services being provided by the facility to which the standards will be applicable (For example common minimum standards framed for a Dispensary are applicable to a Dispensary only and not to a single speciality hospital).

105

B.1. Definition: Clinic

CLINICS DISPENSARIES THERAPY CENTRES

Outdoor care facility managed by a single Siddha medical practitioner or a group of Siddha practitioners with or without a day care facility. No overnight stay or care is provided here. Care is provided by Siddha Medical Practitioner or a group of Siddha practitioners qualified in the concerned system of medicine having graduate or postgraduate qualifications

Dispensary

Outdoor care facility managed by a single Siddha medical practitioner or a group of Siddha practitioners with or without a day care facility along with dispensing unit. No overnight stay or care is provided here. Care is provided by Siddha Medical Practitioner or a group of Siddha practitioners qualified in the concerned system of medicine having graduate or postgraduate qualifications

Therapy Centre

Outdoor care facility managed by a single Siddha medical practitioner or a group of Siddha practitioners with day care facility providing at least any one of the 32 external therapies” or special therapies like Varmam, Yogam, Purgation, therapeutic emesis etc. Care is provided by Siddha Medical Practitioner or a group of Siddha practitioners qualified in the concerned system of medicine having graduate or postgraduate qualifications

B.2. Functions

Clinical Services

Clinic

Dispensary

Therapy Centre

General Siddha Care

Yes

32 External therapies@ / Special Therapies $

Optional

Yes

(At least any one of the procedure/therapy)

Dispensing medicines

Optional

Yes

Optional

@ 32 External Therapies

106

Name of the external therapy Procedure (Pura Marunthukal)

Description

Dressing and Bandaging (Kattu)

The application of medicine made of botanicals, inorganic substances etc. to the affected area and bandaging it.

Poultice (Patru)

Is a soft moist mass, usually made of herbals, which is applied in skin disease as emollient, anti-microbial and anti- allergic.

Fomentation (Õttradam)

Application of hot or cold packs topically.

Painting (Poochu)

Application of liquid formulation locally.

Steam inhalation (Vethu)

1. A steam inhalation and steam application to either localized regions or the whole body.

2. Vapour inhalation. – Vapour bath / Steam bath.

Medicated pouches (Pottanam)

Induction of perspiration by applying heat using heated packs of herbal powder.

Massage manipulation therapy (Thokkanam)

Special therapy consisting of 9 types of manipulation techniques such as pressing, pulling, moving, griping, and striking with fist with or without applying oil in the treatment especially of vatha diseases.

Fumigation (Pukai)

Artificial impregnation of the atmosphere, with the fumes or the smoke of any vegetable or aromatic substance, which is also used in inhalation therapy.

Opthalmic applications (Mai)

A method of applying drugs onto the mucous membrane of one or both eyes. The medication may be in the form of drops directly instilled in the eye or paste form applied in the inner margin of the lower eyelid.

Powder smearing (Podi thimiral)

Rubbing of the whole body with some medicinal substances.

Eye salve (Kalikkam)

Applying eye drops obtained by dissolving medicated pills in honey, breast milk, plant juice etc.

Nasal instillation (Naciyam)

A process by which the drug is administered through the nostrils.

Blowing (Oothal)

The physician chewing the medicated substance and blowing the aroma into the ears or nose of the patient.

Medicated snuff (Akkiranam)

Inhaling medicated substances in powder form.

Ointment (Kalimbu)

A viscous semisolid preparation used topically.

Medicated gauze/Plaster (Seelai)

i) Is a adjunct used for application to a wound in order to promote healing.

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ii) A external covering used in the preparation of medicine.

17.

Medical water for wash (Neer)

Raw drugs are soaked in water or made into decoction to concentrate or powerfully potent substances are greatly diluted and used to wash wounds usually used as anti- septics.- Medicated water for wash.

18.

Medicated Wick (Vartthi)

Prepared by soaking the ribbon gauze in herbal juices/ decoctions/ substances that are ground well with herbals juices/decoctions.

19.

Cauterization (Suttigai)

Burning of the tissues to remove or close a part of it. Usually used to stop heavy bleeding.

Probe (Salagai)

The instrument used for probing. The probe has three faces and made of copper. It should be of 10cms in length and 60 grams in weight.

Ointment/Cream (Pacai)

A semi-solid lipid or resin/gum based applications.

Poultice (Kali)

Medicinal materials are mixed with rice flour or flour of any cereals or pulses and cooked.

Dusting powder (Podi)

Dry fine powder of herbs or inorganic substances used externally.

24.

Therapeutic fracture manipulation (Murichal)

Physical manipulation by which dislocated joints and malunited fractured bones are brought to their normal position by means of either simple reduction or breaking of malunited fractured bones, as it may require.

25.

Incision (Keeral)

A surgical procedure to remove accumulated pus, blood etc.

Caustic ablation (Karam)

Application of drugs to are to be excised or to chronic ulcers, wherein unwanted growth, slough and debris are removed and healing process in initiated. Application of caustic substances.

Leech application (Attai Vidal)

A procedure used to remove toxin from blood using leeches.

28.

Surgical procedures (Aruvai Chikichai )

A set of procedures includes incision, excision, scrapping, puncturing, probing, extraction, letting out of fluid etc.

Bone setting with bamboo splints (Kombu Kattal)

A procedure for immobilising the fractured bone using splints and bandages.

30.

Suction/ Aspiration (Urinjal)

Oral Suction of the accumulated fluids/pus/blood from abscess/ulcers by using instruments.

Blood letting (Kuruthi Vankal)

A procedure used to remove toxins from blood by blood letting.

Enema (Peechu)

Enema using medicated water or medicated oil to evacuate the bowels.

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$ Special Treatment

1. Muthiyor maruthuvam (Geriatric Care)

2. Kuzhanthai Maruthuvam (Paedatric Care)

3. Moola Noigal (Ano-rectal disease)

4. Thottra Noigal (NCD Care)

5. Mano Noi (Psychiatric disease)

6. Narambu Noigal (Neurological disorders)

7. Enbu & Poruthu Noigal (Rhematology & Orthopaedics)

8. Thol Noigal (Dermatology)

9. Kan Noigal (Ophthalmology)

10. Aruvai Maruthuvam (Surgery)

11. Sool & Mahalir Maruthuvam (O & G)

12. Putru Noi (Cancer therapy)

13. Ootachathu Noigal (Nutritional disorders)\

B.3. Physical Facilities

B.3.1. Space Requirement

Clinic

Dispensary

Therapy Centre

Area

80 sq ft

100 sq ft.

200 sq ft.

Rest room

Optional

Yes

B.3.2. Furniture

Consultation Table

Yes

Y es

Yes

Consultation Chair

Yes

Stools / Chairs

Yes

Examination Table / Bed (6 x 2.5 ft)

Yes

Privacy Screen Around Examination Area

Yes

B.3.3. Equipments / Instruments

BP Appratus

Yes

Stethoscope

Yes

Knee Hammer

Yes

Tongue Depressor

Yes

Torch light

Yes

Clinical Thermometer

Yes

Wash Bason with Stand

Yes

Measuring tape

Yes

Surgical Cotton & Gauze

Yes

Neikkuri apparatus

Yes

Weighing machine

Yes

Name Display Board (Doctor Name, Qualification and Centre Name)

Yes

B.3.4. Engineering Services (Electrical & Plumbing)

Electrical – light facility

Electrical – points for use

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Wash Basin

Optional

Fire & Safety measures

Optional

Yes

B.4.Manpower

Manpower

Clinic

Dispensary

Therapy Centre

Institutionally Qualified Siddha Physician

Yes

Pharmacist

(D.Pharm -Siddha /Diploma in Integrated Pharmacy / or Equivalent)

Optional

Yes*

Optional

AYUSH trained Multi Purpose Health Worker (MPHW)

Optional

Yes*

Others (House keeping & Security)

Optional

* At least one per 100 out patients.

B.5. Essential Documents / Records :

Records

Clinic

Dispensary

Therapy Centre

OPD Nominal Register

Yes

OPD Card / Book / Prescription Slip

Yes

Inventory Register (Furniture & Instruments)

Yes

Stock Register

(Main and / or Substore medicines)

Optional

Yes

Optional

Pharmaco-vigilance Record

Optional

Notifiable disease Register

Yes

Medical Certificate File / Forms

Yes

B.6. Drugs

++ As per Department of AYUSH notification – Essential Drug list, March 2013

Clinic

Dispensary

Therapy Centre

Essential Drugs ++

Optional

Yes

Optional

110

B.7. Miscellaneous

Display of Medical Registration Certificate

Yes

Potable Drinking water

Yes

Display of Clinical Establishment Registration

Yes

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C.1. Scope :

D. FUNCTIONS

D.1 Core functions (Hospital)

HOSPITAL

Bed Strength

Scope of Services

Minimum 10 beds

Health Care facility with minimum 10 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Siddha Medical Practitioner or a group of Siddha practitioners qualified in the concerned system of medicine having graduate or preferably postgraduate qualifications

11to25 Beds

Health Care facility with 11 to 25 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by a group of Siddha practitioners qualified in the concerned system of medicine having graduate or preferably postgraduate qualifications

26 to50 Beds

Health Care facility with 26 to 50 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by a group of Siddha practitioners qualified in the concerned system of medicine having graduate or preferably postgraduate qualifications

51 to 100 Beds

Health Care facility with 51 to 100 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by a group of Siddha practitioners qualified in the concerned system of medicine having graduate or preferably postgraduate qualifications

101 and above

Health Care facility with 101 beds and above for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by a group of Siddha practitioners qualified in the concerned system of medicine having graduate or preferably postgraduate qualifications

This section includes the basic services provided by Hospital. It is subdivided into two parts

1. Out-patients facilities – OPD with attached hospitals

2. In-patients facilities – IPD

(A UG / PG (any specialty) Siddha Doctor is enough to provide the clinical service)

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1. Out-patient facilities – OPD with attached hospitals

( Out-patient facilities of health care organizations with Minimum 10 beds, 11 to 30, 31 to 50, 51 to 100, 101 and above bed strengths categories of clinical establishments).

S. No.

Services

Minimum 10 beds

In 11 to 25 beds

26 to 50 beds

51 to 100

101 and above

General Siddha Medical Care

Yes

beds

Yes

Aruvai Maruthuvam

Optional

Kann Maruthuvam

Optional

Karuvakka Maruthuvam

Optional

Yes

Kathu Mookku Thondai Maruthuvam

Optional

Kayakarpam and Yogam

Optional

Yes

Kuzhanthai Maruthuvam

Optional

Mana Noi Maruthuvam

Optional

Muthiyor Maruthuvam

Optional

Yes

10.

Nanju Maruthuvam

Optional

Neerizhivu Maruthuvam

Optional

Yes

Putru Noi Maruthuvam

Optional

Sool and Magalir Maruthuvam (Only antenatal care and Magalir Maruthuvam)

Optional

Sool and Magalir Maruthuv am

14.

Thol Maruthuvam

Optional

Yes

15.

Vatha Noi Maruthuvam

Optional

Yes

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16.

Moola Noigal

Optional

Yes

17.

Thotra Noigal

Optional

Yes

18.

Narambu Noigal

Optional

Yes

Enbu Poruthu Noigal

Optional

Yes

Ootchathu Noigal

Optional

Yes

Gnaananthriya Suththi Parikara Murai (Udal Suththi)

S. No.

Services

Minimu m 10

In11to 25

26 to 50 beds

51 to 100

101 and above

Aga Pura thilam/nei payanbadu (External Internal application of oil and ghee)

beds

Optional

beds

Aga Pura thilam/ nei payanbadu

bAegads Pura thilam/ nei payanbadu

Attai vidal

Optional

Enbu Murivou

Optional

Karanool sikichai(*infrastruct ure requirements will apply)

Optional

Kazhiththal

Optional

Kazhiththa

Kazhiththal

Kuruthi vellipaduthal

Optional

l Optional

Optional

Nasiyam

Optional

Peechu

Optional

Peechu

Suttigai

Optional

Thalaikku ennai varppu

Optional

Yes

Vanthi

Optional

Vanthi

Vethu

Optional

Optiona

Vethu

Thokkanam

Yes

Varmam

Optional

Yes

Maruthuvam

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2. In-patient facilities – IPD

The inpatient department of the hospital shall have separate male and female wards and distribution of beds at the rate of 65 sq.ft. area per bed ward as under

The specialty services may be provided on call duty basis or full time basis

Clinical Services in IPD

S. No.

Services

Minimu m 10

In 11 to 25 beds

26 to 50

51 to 100 beds

101 and above beds

General Siddha Medical Care

Yes

Aruvai Maruthuvam

Optional

Kann Maruthuvam

Optional

Karuvakka Maruthuvam

Optional

Yes

Kathu Mookku Thondai Maruthuvam

Optional

Kayakarpam and Yogam

Optional

Yes

Kuzhanthai Maruthuvam

Optional

Mana Noi Maruthuvam

Optional

Muthiyor Maruthuvam

Optional

Yes

10.

Nanju Maruthuvam

Optional

11.

Neerizhivu Maruthuvam

Optional

Yes

Putru Noi Maruthuvam

Optional

Thol Maruthuvam

Optional

Yes

Vatha Noi Maruthuvam

Optional

Yes

Neerizhivu Maruthuvam

Optional

Yes

Putru Noi Maruthuvam

Optional

Sool and Magalir Maruthuvam (Only

Optional

Sool and Magalir

beds beds

115

antenatal care and Magalir Maruthuvam)

Maruthuvam

Moola Noigal

Optional

Yes

Thotra Noigal

Optional

Yes

Narambu Noigal

Optional

Yes

Enbu Poruthu Noigal

Optional

Yes

Ootchathu Noigal

Optional

Yes

Attai vidal

Optional

Enbu Murivou

Optional

Karanool sikichai (*infrastructure requirements will apply)

Optional

Kazhiththal

Optional

Yes

Kuruthi vellipaduthal

Optional

Nasiyam

Optional

Peechu

Optional

Peechu

Suttigai

Optional

Thalaikku ennai varppu

Optional

Yes

Vanthi

Optional

Vanthi

Vethu

Optional

Vethu

Thokkanam

Yes

Varma Maruthuvam

Optional

Yes

Puramaruthuva muraigal (External Therapeutic techniques)

Appropriate procedures may be applied on need based E.1 Auxiliary Functions (support services for ex – diagnostic)

(Central Laboratory for clinical diagnosis and investigations)- upto 50 bed IPD Hospital, this services may be outsourced or tie up with other Institutions / Laboratories

3. There shall be a central laboratory in the hospital complex with proper infrastructure and manpower for carrying out routine, pathological, biochemical and hematological investigations on the

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patients referred from outdoor and indoor departments of the hospital.

4. There shall be a central Imaging- X-Ray unit in the hospital complex with proper infrastructure and manpower for carrying out routine, imaging investigations on the patients referred from outdoor and indoor departments of the hospital.

Support Services:

1. Accounting,

2. Ambulance services

3. Billing

4. Dietary services/ Canteen

5. Essential commodities like water supply, electric supply etc.

6. Finance

7. Financial accounting and auditing

8. Housekeeping and Sanitation

9. Inventory Management

10. Laundry services

11. Medical records

12. Medico legal

13. Office Management (Provision should be made for computerized

medical records with anti-virus facilities whereas alternate

records should also be maintained)

14. Personnel Department

15. Pharmacy/ dispensary

16. Purchase

17. Reception,

18. Security services

19. Stores

20. Waste management Housekeeping/ sanitation,

F. Physical Facilities F.1 Space requirement

This entails the minimum space required for carrying out the basic functions of the facility which includes:

F.1.1 Minimum area required for establishing the facility:

Type of Health Care Organization

Requirements

Stand alone building

Part of another building

1to10bed

As permitted under Development control rules, Floor Space Index,

Local regulations, etc.

Local regulations related to building structures, occupancy, etc. will be followed.

11to25

26to50

51 to 100

101 and above / Teaching Hospitals

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F.1.2 Functional space planning of the facility like reception area, waiting area etc.

1. Consultation & examination room

a. Minimum 10ft. x 8 ft.

b. Consultation room should be adequate to accommodate:

i. Doctors table, Consultation chair, Two stools/ chairs,

ii. Examination bed of the size 6 ft X 2.5 ft.,

iii. Privacy screen around examination area while having free mobility

2. Treatmentrooms:

a. Maximum 30 Treatments/Day/Treatment Room.

b. Number of treatments will depend on type & nature of

treatments.

c. May include Puramaruthuvam treatment (External Therapy

procedures) alao.

3. Yoga Demonstration and practice rooms:

a. Yes for hospitals of size over 50 beds and above.

b. Room should be spacious enough for practicing Yoga, Meditation

etc.,

4. Pharmacy/Dispensary specs:

a. The pharmacy should be located in an area conveniently accessible

b. Temperature & humidity to be maintained as per the requirement of the stored medications.

c. The size should be adequate to contain 5 percent of the total clinical visits to the OPD in one session for hospitals more than 50 beds.

d. Pharmacy should have adequate medicine storage, compounding and dispensing facility for indoor and outdoor patients.

5. Entrance hall with reception area, enquiry counter, cash counter and record area

a. Preferably 100 sq. ft per 25 beds

6. Waiting area in entire organization

a. Preferably 100 sq. ft per 25 beds i.e. 10% seats of average number of patients visiting daily to hospital

7. Kitchen area: Applicable only if food is cooked in the hospital. Providing food is Yes for hospitals of size over 100 beds.

a. Kitchen area should be sufficient size to prepare food for inpatients as per diet advised by the physician

b. Kitchen layout and functioning should follow the flow of materials as: Entry-> washing->cutting-> cooking->loadingTo Serve

c. Utensil washing area is separate from the cooking area.

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8. Medical Stores specs:

a. The medical store may be part of pharmacy or separate and secured.

b. Area should be clean, well ventilated, well lit, without any dampness or fungal growth on walls.

9. RMO Room / Quarters:

a. Minimum 1 room with attached bathroom & WC with ceiling fan, drinking water facility, intercom, mattress, pillows, blankets, bed sheets. Cupboards/ wardrobes.

10.Nursing station/ duty room (Nurses):

a. One nursing station/room per minimum 25 beds.

b. Nursing stations should be spacious enough to accommodate a table, requisite chairs, working platform, medicine racks, a work

counter, sinks, dress table, screen, pedal operated trash bins.

11.Clinical laboratory specifications:

a. Laboratory services can be outsourced or can be optional for hospitals up to 50 beds.

b. Laboratory services are mandatory for hospitals above 50 beds for quick diagnosis of blood, urine, etc., a small sample collection room facility shall be provided. The required area for collection and examination be atleast 150 sq.ft

c. Separate Reporting Room for doctors should be there.

12.Radiology section:

a. Role of imaging department should be radio-diagnosis and ultrasound along with hire facilities depending on the bed strength.

b. The department should be located at a place which is accessible to both OPD and wards and also to operation theatre department.

c. The size of the room should depend on the type of instrument installed.

d. It should confirm to AERB requirements.

e. The room should have a sub-waiting area with toilet facility and

a change room facility, if required.

f. Film developing and processing (dark room) shall be provided in

the department for loading, unloading, developing and

processing of X-ray films.

g. Separate Reporting Room for doctors should be provided.

13.Laundry (optional)

a. Laundry services can be outsourced or can be optional.

b. If it is provided in house, it should have necessary facilities for

drying, pressing and storage of soiled and cleaned linens.

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c. If outsourced, disinfection of linen is carried out by the hospital before handing over the linen to the out-sourced organization.

14. Emergency Room specifications:

a. Emergency room should be spacious enough to accommodate a table, requisite chairs, working platform, medicine racks, a work counter, sinks, dress table, screen, pedal operated trash bins.

b. Station should accommodate nurses & doctors on duty at any time.

c. Room should allow free movement of wheel chair or trolley.

d. Emergency Room should preferably have different entry than the

hospital entry.

e. Access to Emergency Room should have a ramp for wheel chairs

and stretchers.

15. House-Keeping:

b. c.

Housekeeping services should be made available for effective cleanliness.

Housekeeping services can be outsourced.

Designated areas within functional areas for housekeeping materials has to be in hospital

16.Security Services:

a. There is a designated location for each security staff on duty.

17.Medical record-room:

a. Medical record-room should be of adequate size as per the load of the documents of the hospital.

b. Tamperproof material and locking facility Cabinets/ cupboards/ Boxes will be used.

c. Fire extinguishers of correct type should be made available nearby all locations.

18.Store rooms:

a. Store room should be lockable & of adequate size with exhaust fan.

b. Area should be clean, well ventilated, well lit, without any dampness or fungal growth on walls.

19. Wards:

b. The ward planning will address minimization of the work for the nursing staff and shall provide basic amenities to the patients located within an area or unit.

c. Ward unit will include nursing station, preferably a treatment/ procedure room, nursing store and toilets as per the norms.

120

d. At the minimum one nursing station per ward of up to 25 beds will be provided.

e. There should be minimum 70 sq.ft. area per bed with 7 ft. distance between the mid-points of adjoining beds and at least 3 feet distance between the beds and 8 inch distance between the bed and the wall.

f. Width of the door to be at least 4 feet.

g. Permanent, semi-permanent or temporary partition should be

present between two beds.

h. Ward store area with lockable wall or steel cupboard(s).

20.Duty rooms for doctors

a. To accommodate 1 bed of 6 feet X 3 feet and a side table.

b. Separate beds if sharing for same gender.

c. Separate rooms for separate genders will be provided.

21.Duty rooms for nurses:

a. To accommodate 1 bed of 6 feet X 3 feet and a side table.

b. Separate beds if sharing for same gender.

c. Separate rooms for separate genders will be provided.

22.Duty rooms for technicians:

a. To accommodate 1 bed of 6 feet X 3 feet and a side table.

b. Separate beds if sharing for same gender.

c. Separate rooms for separate genders will be provided.

23.Dirty utility room:

a. Separate area of minimum 15 sq feet.

24. Pura Maruthuvam(External) Therapy Unit or treatment room:

c. The department is more frequently visited by out-patients and IPD patients but should be located at a place which may be at convenient access to both out-patients and in-patients with privacy.

F.1.3 Dimensions of the sub areas of the facility, including the flow of the processes which in turn will give a layout of the department /unit.

F.1.3.1 Specifications of the Pura Maruthuvam(External)Therapy Unit:

5. Yes if procedures are done.

6. Room Size: Minimum 10 ft. X 10 ft. (As size of massage table/ Droni is 7ft

X 3 ft. the size of room should be 10ft X 10 ft.)

7. Separate Unit is proposed for male & female with attached toilet and

bathroom

8. Optional and depending on work load. If more than 30 procedures are

carried out per day, separate rooms should be provided.

F.1.3.2 Specifications of the Minor OT for Kaara Nool Chikitsai:

1. Minor OT is Yes if surgical procedures are provided in any hospital.

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2. Minor OT room should have sterile zone of at least 10 ft X 10 ft; Size is exclusive of clean zone, independent enclosure to accommodate Kaara Nool Chikitsai equipment & maintaining adequate privacy.

3. Sterilization room: adequate to accommodate sterilization equipment & sterilized material.

4. Separate disposal zone for storage of waste as per bio-medical waste management rules.

F.1.4 Basic signage

3. A signage within or outside the facility should be made available containing the following information.

4. All signage meant for patients and visitors shall be bilingual – Local language and Hindi / English.

F.1.4.1 Name of the care provider with registration number,

3. Name of organization.

4. Display of Registration under clinical establishment act

5. Name of Doctor, Qualification, Registration Number

F.1.4.2 Fee structure,

3. Display of tariff list at OPD & IPD.

4. Display of citizen charter in OPD and IPD

F.1.4.3 Timings of the facility

2. Display of OPD timings with names and respective specializations of consultants in OPD & IPD Duty Doctor, Nurse, Attendant details – wardwise

F.1.4.4 Services provided

9. Directional signage at main entrance towards OPD & IPD

10. Directional signage for patients for utilities and conveniences like

toilets, drinking water, telephone booths, shops

11. Directional signage within the hospital building for all departments

within the building

12. Display of department / area name on the entrance of each area / room

/ counter

13. Display of hospital layout at various entrances in the hospital

14. Display of hospital’s scope of services at OPD, IPD and at Campus

entrance

15. Floor Plan With Location Of Departments

16. Plan of Facility

17.usages: departments, OPD & IP room & wards, waiting areas,

F.1.5 Others

21. Display of all radiation hazard signage in radiation areas (if applicable).

22. Display of Biomedical waste segregation at all location where BMW

bins are kept

23. Display of danger signage at all electric panels and other dangerous

areas

122

24. Display of General instructions like ‘No Smoking’, ‘Keep Silence’, ‘Use dustbin’, etc. at various patient and visitor areas in the hospital

25. Display of hand–washing techniques compliant with WHO guidelines at all hand wash basins

26. Display of how to use fire extinguisher at all point where fire extinguisher is installed

27. Display of important phone contact numbers of hospital authorities

28. Displays required by regulations like PC PNDT, Lifts, Fire, etc.

29. Display of Material Safety Data Sheet at all locations where Hazardous

Materials are stored

30. Display of patient rights and responsibilities in OPD, IPD and

emergency

31. Display of safety instructions in areas where any kind of safety hazard

may be expected. This includes areas like transformers, Cylinder

storage, LPG storage etc.

32. Emergency exit signage (preferably in auto illumination material, like

radium)

33. Fire Protection

34. Hazards- electrical, fall, pipe locations, prohibited areas

35. Notice board for general information to staff

36. Notice board in front of all OPD and IP Wards.

37. Notice board in Minor Operation theatre

38. Routes for all areas

39. Signage for parking. (Signage for ambulance parking shall be separately

mentioned)

40. Safety signage will be displays as per the requirements of respective

Indian Standards: Ex. Fire Protection Safety Signs IS 12349:1988

F.2 Furniture & Fixtures:

This will entail the details about the furniture and sundry items

commensurate to the service delivery requirements. C.2.1 Furniture/Fixture Requirements:

1: Furniture / Fixture Requirements for Outpatient Department (OPD)

Sl. No.

Name of the Equipment

Minimum 10 bedded Hospital

11-25 bedded Hospit al

26-50 bedded Hospital

51-100

bedded Hospital

101 and above bedded hospital

(Per Consulting Room)

Room with well-lighted and ventilated and equipped with a chair and a table for doctor

X-ray viewer

two chairs for patients & attendants

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An examination table of 6 ft. X 2.5 ft. With privacy screen

Blood pressure apparatus,

Stethoscope

Torch,

Thermometer

Weighing machine.

10.

Essential diagnostic tools required for examination of patients as per the scope of services offered by the hospital.

As required

11.

Light source which gives light colour and temperature similar to solar light,

Light intensity of at least 500 lux at the point of examination.

As required

12.

Refrigerator if temperature sensitive medication are stored (if required)

13.

Telephone Equipment – (Intercom)

As required

14.

Air conditioning

As required

15.

Adequate lockable storage space

As required

16.

Foot stools

1 Per-CR means 1 per Consultation Room

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2. Furniture / Fixture Requirements for In-Patient Department (IPD) – Male and Female ward separately:

Sr. No.

Name of the Equipment

Minimum 10 bedded Hospital

11-30 bedded Hospital

31-50 bedded Hospital

51-100 bedded Hospital

101 and above bedded hospital

Adequate wall or steel Cupboards

Arm Board Adult

Back rest

Bain Marie trolley stainless steel 1 per floor

1 per floor

Bed side cabinets

1 per 5 patients

Bed side Screen

1 per ward or full length curtains between the beds

Bucket Plastic

Ceiling Fans

As required

Clock 1per ward

1 per ward

10.

Containers for kitchen

As required

11.

Doctor’s chair for OP & ward,

As required

12.

Doctor’s or Office table

13.

Dressing trolley-1 per floor/ ward depending on layout

14.

Dust bins in each ward & consultation room

15.

Duty table for nurses

16.

Emergency resuscitation kit

1 per floor

17.

Enema Set

18.

Fire extinguisher

ABC 1 per ward/ floor based on layout

19.

Foot stools

20.

Refrigerator

1 Per Area/ Ward

21.

Heavy duty Torch light

1 per ward

22.

Hospital Cots

As per beds

23.

Hospital Cots Pediatric

As required

24.

Hot Water Bags 2 per

2 per ward

125

ward

25.

Hot Water geyser

2 per ward

26.

I V Stands – 2 per 10 beds

As required

27.

Infra-Red lamp

28.

Intercom System

2 per ward

29.

Kidney Trays1 per 5 beds

30.

Kitchen utensils,

Adequate

31.

Massage table of 7ft. x 2.5 ft (wood or fiber)

One per procedure room

32.

Medicine trolley

1 per ward

33.

Office chairs

34.

Office Table

35.

patient Beds with side rails

20% of total beds

36.

Patient call Bell System

1 per bed

37.

Patient locker

1 per bed

38.

Patients examination table– 1 per ward/ floor as per the profile of patients & layout of facility

1 per ward/ floor as per the profile of patients & layout of facility

39.

Patients side table

1 per bed

40.

Pediatric cots with railings as per scope of services

as per scope of services

41.

Steel or Wooden cup board

42.

Steel rack

43.

Stool 1 Per Bed

As required

44.

Stretcher/ Patient trolley – 1 per ward

1 per ward

45.

Urinal Male and Female

(For every 10 bed)

2 (1-M,1-F)

4 (2-M 2- F)

As required

46.

waiting chairs / benches for patients relatives

50% of the bed strengths

47.

Weighing Machine

1 per ward

126

48.

Wheel chair

49.

Wooden massage bed

One per SR

50.

X-ray viewer

one per ward

SR – Service Room

3. Furniture / Fixture Requirements for Pura Maruthuvam Therapy Room

Sr. No.

Name of the Equipment

Minimum 10 bedded Hospital

11-25 bedded Hospital

26-50 bedded Hospital

51-100 bedded Hospital

101 and above bedded hospital

Per Service Room

Appropriate stand to fix droni : 2.5ft. height

Arm chair

Droni: Minimum 7ft. x 2.5ft (wood or fiber)

Footstool

Gas/Stove

hamox stretchers / Stretchers with wheels

Heating facilities

Hot water bath

IV stands

10.

Massage table of 7ft. x 2.5 ft (wood or fiber)

11.

Mixture/Grinder/Churner

12.

Plastic aprons, gloves and mask

13.

Pressure cooker (5 liters) meant for Vedhu

14.

Thalaikku Ennai Varppu stand and table

15.

Stool

16.

Sufficient light and ventilation

17.

Viyarvai chamber

18.

Vanthi set

19.

Vanthipeedam (Adjustable chair)

20.

Wheel chairs

21.

For Peechu

22.

OT Table having bars for giving lithotomy position

23.

Revolving stools

24.

Focus lamp

127

25.

Torch

26.

Good light source

27.

Karanool sikichai cabinet

Optional

28.

OT table / Lithotomy Table with Side Railings

29.

OT light

30.

Attai Vidal (Leech Therapy)

Optional

31.

Storage Aquarium for fresh leeches: 20-25 liters capacity (may be with partitions)

5-10

32.

Glass containers (1 liter capacity) for storing used leeches:

33.

Examination table

34.

Surgical Trolly

F.2.2 Sundry Articles Requirement

Furniture / Fixture Requirements – Hospital Fittings & Necessities

Sr. No.

Name of the Equipment

Minimum 10 bedded Hospital

11-25 bedded Hospital

26-50 bedded Hospital

51-100 bedded Hospital

101- 200 bedded hospital

Air conditioners for OT

Optional

Minimum 1

Ambulance

Optional

Minimum 1

Ceiling / wall Fans

As required

Clock

1 per ward

Coolers

As required

Drinking Water purifier

Emergency lamp

2 Per Area/ Ward

Emergency trauma set

2 per ward

Exhaust Fan

As required

10.

Fire extinguishers

As required

11.

Geyser

1 per ward

12.

Refrigerator

1 per ward

13.

Storage Geyser

1 per ward

14.

Tables & Chairs

As required

15.

Telephone/ cell phone

1 per ward

16.

Tube lights

As required

17.

Vacuum cleaner

As required

128

F.2.3 Others

Sr. No.

Name of the Equipment

Minimum 10 bedded Hospital

11-26 bedded Hospital

26-50 bedded Hospital

51-100 bedded Hospital

101 and above bedded hospital

Computer with Modem with UPS, Printer with Internet Connection

Minimum 1

Minimum 2

Minimum 3

Minimum 4

Photocopier Machine

Minimum 1

Intercom (10 lines)

As needed

Fax Machine

Minimum 1

Telephone

One per organization

Public Address System

Covering Indoor and OPD Areas

F. 3 Engineering Services Requirements

This will include the detail information about the basic requirements including

F.3.1 Electrical Requirements

7. At least 3 hours backup or generator for critical areas

8. Primary electrical Supply is available as provided by the local utility

provider. Lighting back up for at least 1 hour covering all functional areas

must be available during the functioning time.

9. Primary electrical Supply as supplied by utility provider. Emergency

backup for at least 3 hours backup for electricity & for lighting and critical equipment must be available during the functioning time. Take over time must be less than 30 seconds. Electric supply to lighting will be backed up with UPS/ Inverter/ Battery.

10.The illumination in the hospital is provided as per the prescribed standards.

11.Shadow less lights should be provided in operation theatres and delivery rooms.

12.Emergency portable light units should be provided in the wards and departments.

F.3.2 Plumbing Requirements 2. For in-patient department

d. No. of Wash basins

i. 1 for every 10 beds or part thereof

ii. Doctor, staff, patients and visitors have an access to wash basin(s);

129

iii. Procedure hand wash basins are separate and located close to procedure area.1 for every 10 beds or part thereof

No. of Water closets

i. 1 for every 6 beds or part thereof

ii. Separate water closets are available for use for outpatient and in-patient areas.

iii. For in-patient areas the water closets are provided in the ratio of 1 per 6 beds and are located close to patient care areas.

No. of bathrooms

i. Minimum 1 bathroom per 6 beds/ one for each ward rooms

ii. Minimum 1 bathroom per 6 beds/ one for each therapy rooms

F.3.3 Civil Requirements

7. Space between 2 rows of beds in a ward should be minimum 5 ft.

8. Distance between 2 beds should be minimum 3.5 ft. if more than one bed is

present

9. If clinic has beds then: measured between the facing borders of adjoining

beds there shall be at least 3 feet of distance if the beds are mobile and provided with functional wheels and at least 4 feet if beds do not have functional wheels.

10. If there are no beds then this requirement is not applicable.

11. Size of hospital bed should be minimum 6’ x 3’

12. Area per bed should be Minimum 50 sq. ft. / bed

F.3.4 HVAC / AC / Ventilation / Cross Ventilation Requirements

4. Air-conditioning and Room Heating in operation theatre and neo-natal units should be provided.

5. The ventilation in the hospital may be achieved by either natural supply or by mechanical exhaust of air.

6. Cross ventilation/ Mechanical ventilation by fans and or exhausts to achieve comfortable environment without noxious odours.

F.3.5 Others

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

F.4 Public Utilities F.4.1 Safe drinking water

3. Round the clock availability of safe drinking water for patients, staff and visitors.

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

F.4.2 Sanitary Requirements

5. Arrangement should be made for round the clock piped water supply along with an overhead water storage tank with pumping and boosting arrangements.

130

6. Approximately 10000 liters of potable water per day is required for a 100 bedded hospital.

7. Separate provision for fire fighting should be available.

8. Water softening plant should be considered where hardness of water is a

major problem.

Drainage and Sanitation

3. 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.

4. Waste Disposal System:

National guidelines on Bio-Medical Waste Management and a Notification

of Environment and Forests are at Annexure – I.

G. Equipments /instruments

This includes the type, number, minimum specification & functionality of

equipments required in the facility under the following headings.

G.1 Therapeutic equipments

1. Equipments / Instruments Requirements for Outpatient Department

Sl. No.

Name of the Equipment

10 bedded Hospital

11-25 bedded Hospital

25-50 bedded hospital

51-100 bedded hospital

101 & above Bedded hospital

A chair and a table for doctor

1 perCR

X-ray viewer

1 perCR

An examination table of 6 ft. X 2.5 ft. With privacy screen

1 perCR

Blood pressure apparatus,

1 perCR

Stethoscope

1 perCR 1 perCR

1 perCR

Torch

1 perCR 1 perCR

Thermometer

1 per CR

Weighing machine.

1 perCR

Light source which gives light colour and temperature similar to solar light, Light intensity of at least 500 lux at the point of examination.

Minimum 1

As required

10.

Knee Hammer

Minimum 1

131

11.

Otoscope

As required

12.

Tuning Fork (minimum)

13.

Measuring Tape(minimum)

14.

Tongue Depressor ( minimum)

15.

Glucometer

As required

2: In-Patient department (IPD)

2. Equipments / Instruments for in-patient department (IPD)

Sr. No.

Name of the Equipment

10 bedded Hospital

11-25 bedded Hospital

26 -50 bedded hospital

51-100 bedded hospital

101 & above bedded

Ambu bags

Arm Board Adult

1/ward

Autoclave Drums

Back rest

Bain marie trolley stainless steel 1 per floor

—

Bed pans, 1 per 5 patients

Biomedical waste colour code bins

Each per floor

Cheatle forceps assorted

sizes

Clock per ward

1 per ward

10.

Containers for kitchen

As required

11.

Dressing trolley-1 per floor/ ward depending on layout

1 per ward

12.

Dust bins in each ward & consultation room

1 per ward

13.

Emergency resuscitation kit

1 per floor

14.

Enema Set

As required

15.

Refrigerator

As required

16.

Heavy duty Torch light

1 per ward

17.

Hot Water Bags

2 per ward

18.

I V Stands – 2 per 10 beds

2 per 10 beds

19.

Infra-Red lamp

132

20.

Instrument tray – minimum 1 per ward

minimum 1 per ward

21.

Intercom System

As required

22.

Kidney Trays

1 per 5 beds

23.

Massage table of 7ft. x 2.5ft (wood or fiber)/ Wooden massage bed

1 per treatment room

24.

Medicine trolley

minimum 1 per ward

25.

Needle cutter – 3 per ward

1 per ward

26.

Non mercury Thermometer clinical – 1 per ward

1 per ward

27.

O2 cylinder with spanner – 1 per ward

1 per ward

28.

Patients examination table– 1 per ward/ floor a per the profile of patients & layout of facility

1 per ward

29.

Sphygmomanometers- Stand Type 1& Portable (aneroid or Digital) Type X 1 – 1 per ward

1 per ward

30.

Stretcher/ Patient trolley – 1 per ward

1 per ward

31.

Weighing Machine – 1 per ward

1 per ward

32.

X-ray viewer – one per ward

1 per ward

33.

Nebulizer

—

1 per ward

133

3. Equipments / Instruments Karanool / Leech therapy Room I Karanool

Sr. No.

Name of the Equipment

10 bedded Hospital

11-25 bedded Hospital

26-50 bedded hospital

51-100 bedded hospital

101-200

Bedded hospital

55.

Karanool cabinet

Optional

56.

OT table / Lithotomy Table with Side Railings

Optional

1 /Theatre

57.

OT light

Optional

1 /Theatre

58.

Autoclave

Optional

1 /Theatre

59.

Autoclave Drum/ tray(s)

Optional

1 /Theatre

60.

Consumables

Optional

1 /Theatre

61.

crash cart

Optional

1 /Theatre

62.

Sterile apron

Optional

1 /Theatre

63.

OT instruments

Optional

1 /Theatre

64.

OT light

Optional

1 /Theatre

65.

Surgical trolley

Optional

1 /Theatre

66.

Torch (Medium Size)

Optional

1 /Theatre

67.

Karanool Probes

Optional

As required

68.

Steriliser

Optional

Min 1

69.

Pedestal Shadowless lamp

Optional

Min 1

70.

Surgical Instruments

Optional

As needed

II Attai Vidal (Leech Therapy):

Sr. No.

Name of the Equipment

10 bedded Hospital

11-25 bedded Hospital

26-50 bedded hospital

51-100 bedded hospital

101-200

Bedded hospital

71.

Storage Aquarium for fresh leeches: 20-25 liters capacity (may be with partitions)

Optional

72.

Glass containers (1 liter capacity) for storing used

Optional

134

leeches:5-10 (for each patient requires separate container and the number may vary according to the number of patients)

73.

Examination table

Optional

74.

Surgical trolley

Optional

75.

Leeches :As per the requirement, usually 3-5 leeches per patient/ treatment period)

Optional

76.

Surgical tray

Optional

77.

Instruments : Different types of Forceps, Scissors, Needles, Suturing material etc. (as per requirement)

Optional

78.

As per requirement: Dressing tray with gloves, bandage cloth, bandages etc.

Optional

79.

Materials: Turmeric, Saindhavalavana, Jatyadi ghrita, honey. (as per requirement)

Optional

G.2 Surgical equipments

1. Equipment Requirement for Minor Operation Theatre (MOT)

Sl. No.

Name of the Equipment

10 bedded Hospital

11-25 bedded Hospital

26-50 bedded hospital

51-100 bedded hospital

101 & above Bedded hospital

Anterior vaginal wall retractor

Optional

As needed

Artery forceps

Optional

As needed

Auto Clave HP Vertical (2 bin)

Optional

As needed

Autoclave equipment for sterilization/Sterilizer

Optional

As needed

Bla5d.der sound (Urethral dilators) of different sizes

Optional

As needed

135

Crash Cart with lifesaving drugs and Resuscitation Kit

Optional

As needed

Cusco’s Speculum

Optional

As needed

Diathermy Machine (Electric Cautery)

Optional

As needed

Disposable syringes (5-10cc)

Optional

As needed

10.

Enema Pot

Optional

As needed

11.

Focus lamp Ordinary

Optional

As needed

12.

Foley’s Catheter

Optional

As needed

13.

Formaline dispenser

Optional

As needed

14.

General Surgical Instrument Set Piles, Fistula, Fissure

Optional

As needed

15.

Instrument Trays of various Sizes

Optional

As needed

16.

Instrument Trolley

Optional

As needed

17.

IV stands

Optional

As needed

18.

Kidney tray

Optional

As needed

19.

Knife and scissor1 each

Optional

As needed

20.

L. P. Tray

Optional

As needed

21.

Magill’s forceps (two sizes)

Optional

As needed

22.

Metallic or disposable insemination cannula

Optional

As needed

23.

Operation table Hydraulic Minor with stand

Optional

Min 1/Theatre

24.

OT Spot light (Shadowless ceiling fitted/ stand mounted)

Optional

Min 1/Theatre

25.

Oxygen Cylinder

Optional

Min 1/Theatre

26.

Shadowless lamp ceiling type major / minor

Optional

Min 1/Theatre

27.

Shadowless Lamp stand model

Optional

Min 1/Theatre

28.

Sims speculum in small, medium & large size

Optional

As needed

29.

Sphygmomanometer

Optional

Min 1/ OT

136

30.

Steriliser Small (Instruments)

Optional

Min 1/ OT

31.

Sterilizer big (Instrument)

Optional

Min 1/ OT

32.

Sterilizer Medium (Instrument)

Optional

Min 1/ OT

33.

Stethoscope

Optional

Min 1/ OT

34.

Suction Apparatus – Electrical

Optional

Min 1/ OT

35.

Suturing Set

Optional

As needed

36.

Swab holders

Optional

As needed

37.

Thermometer

Optional

As needed

38.

Tongue depressors

Optional

As needed

39.

Toothed forceps

Optional

As needed

40.

two long (8 inch)& two short (6 inch) Artery forceps

Optional

As needed

41.

two Uterine sound

Optional

As needed

42.

Uretheral Dilator Set

Optional

As needed

43.

Vaginal Examination set

Optional

Min 1/OT

44.

Vulsellum

Optional

Min1/OT

G.3 Diagnostic equipments 1: Imaging Equipment

Sr. No.

1. 2.

3. 4. 5. 6. 7.

Name of the Equipment

300 M.A. X-ray machine

Ultra Sonogram (Obs & Gyne. department should be having a separate ultra-sound machine of its own)

Echocardiogram

X-ray developing tank Safe light X-ray dark room Cassettes X-ray

Lead apron

10 bedded Hospital

Optional Optional

Optional Optional Optional Optional Optional

11-25 bedded Hospital

Optional Optional

Optional Optional Optional Optional Optional

26-50 bedded hospital

Optional Optional

Optional Optional Optional Optional Optional

51-100 bedded hospital

Min1 Optional

Optional Min 1 Min 1 Min 1 Min 1

101 & above Bedded hospital

Min1 Min1

Optional Min 1 Min 1 Min 1 Min 1

137

8. Intensifying screen X-ray

9. Thyroid shield

10. TLD batches

11. Gonadial guard

12. X-ray lobby single

13. Automatic ECG

2: Laboratory Equipments

Optional Optional Optional Optional Optional Min 1

Min 1 Min 1 Min 1 Min 1 Min 1 Min 1

Sl. No

Name of the Equipment

10 bedded Hospital

11-25 bedded Hospital

26-50 bedded hospital

51-100 bedded hospital

101 & above Bedded hospital

Alarm clock

Min 1

Automatic cell counter

Optional

Min 1

Auto analyzer/ Semi auto analyzer

Optional

Min 1

Binocular Microscope

Min 1

Min 3

Chemical Balances

Min 1

Counting chamber

Min 1

Electric Colorimeter

Min 1

Electricentrifuge, table top

Min 1

ESR stand with tubes

Min 1

10.

Photo colorimeter

Min 1

11.

Glucometer

1 Per Area/ Ward

12.

Hemoglobinometer

Min 1

13.

Hot air oven

As required

14.

Hot plates

As required

15.

Lab Incubator*

As required

16.

Laboratory Auto Claves

As required

17.

Micro pipette of different volumes

As required

18.

PH meter

As required

138

Sl. No

Name of the Equipment

10 bedded Hospital

11-25 bedded Hospital

26-50 bedded hospital

51-100 bedded hospital

101 & above Bedded hospital

19.

Refrigerator

Min 1

20.

Rotor / Shaker

Min 1

21.

Simple balances

Min 1

22.

Spirit lamp

Min 1

23.

TCDC count apparatus

Min 1

24.

Test tube holders

As required

25.

Test tube rack

As required

26.

Test tube stands

As required

27.

Timer stop watch

As required

28.

Water bath

As required

29.

ELISA reader & washer

Optional

Min 1

30.

Fully automated analyser

Optional

Min 1

31.

Laminar air flow chamber

Optional

Min 1

32.

Cold centrifuge

Optional

Min 1

33.

Incubator

Optional

Min 1

34.

Sample Shaker

Optional

Min 1

H. Manpower

This includes the Designation, minimum qualification & number of people required in the facility.

H.1 Medical practitioners

1. Category: Doctors

2. Minimum Qualifications: Degree/ Post Graduate Degreeor Post

Graduate Diploma from recognized university by Central Government

or State government of Indian Medicine.

3. Registration: (if applicable): with state or central council of Indian

Medicine

4. Trained / skilled: Trained

139

Doctors BSMS/ MD

Min 10 beds

11-25 beds

26-50 beds

51-100 beds

101 & above beds

Hospital Superintendent

–

BSMS – General Siddha Medical Care

Spl – Pothu Maruthuvam

Specialty Service of Sl.No 3-13 may be provided by engaging MD / PG Diploma qualified Doctor on hire or contract basis or full time basis as per the requirement

Spl- Kathu Mooku Thondai Maruthuvam

Spl- Sool Magalir Maruthuvam

Spl- Kuzhanthai Maruthuvam

Spl- Varma Maruthuvam

Spl – Putru Noi Maruthuvam

Spl- Vatha Noi Maruthuvam

10.

Spl – Thol Maruthuvam

11.

Spl – Neerizhlvu Maruthuvam

12.

Spl – Muthiyor Maruthuvam

13.

Spl – Kayakarpam and Yogam

14.

Anesthetist

Optional

15.

Radiologist

DMRE/ MD in concerned subject

Optional

16.

Pathologist (visiting/part time/full time)

Option al

Optional

17.

Casualty Doctor / General Duty Doctor

140

H.2 Therapists:

5. Category: Masseur Technicians

6. Minimum Qualifications: (diploma/degree from recognized university by Central Government or State government of Indian Medicine.)

a. Masseur Technicians should have at least done certified course in Masseur of at least 6 months – 1 year duration as recognized by state of central council for Indian Medicine .

b. Masseur Assistant should have at least done certified course in Masseur of at least 6 months duration as recognized by state of central council for Indian Medicine .

7. Registration: (if applicable): state or central council of Indian Medicine

8. Trained / skilled: Trained

(As per Minimum standard requirement of Hospital attached with colleges)

Strength: Minimum 1 per treatment room; male and female separate; i.e. minimum 1 male technicians or 1 female technicians for a treatment room.

Therapists – Technicians

Min 10 bedded Hospital

11-25 bedded Hospital

26-50 bedded hospital

51-100 bedded Hospital

101 & above bedded Hospital

Varmam,Puramaruthuvam

(Masseur) Technicians- Female

Varmam,Puramaruthuvam

(Masseur) Technicians- Male

Varmam,Puramaruthuvam

(Masseur) Assistant – Female

Varmam,Puramaruthuvam (Masseur) Assistant Male

H.3 Paramedics

5. Category: Paramedics

6. Minimum Qualifications: (diploma/degree from recognized university by

Central Government or State government of Indian Medicine.)

7. Registration with the concerned council(if applicable): state or central council

8. Trained / skilled: Trained

141

Paramedics

Minimum qualification

Min 10 bedded Hospital

11-25 bedded Hospital

26-50 bedded hospital

51-100 bedded hospita l

101 & above bedded hospital

ECG Technician

(if ECG services are provided in- house)

1 year experience of taking ECG

Hospital worker

Eight standard completed

Laboratory +OT)

Attendant (Hospital Worker)

(if lab is in-

Ability to read national or local language

Lhaobuosera)tory Technician

(if Lab is in- house)

Qualified Laboratory Technician

Medical Records Officer /

Minimum qualification- 12th Standard passed.

Technician OT Assistant

(if surgical services are provided)

Minimum qualification- 12th Standard passed.

Radiographer

(if Imaging is in-house)

Qualified Radiographer

Therapy Assistant

Minimum 1

Eight standard completed

As required

Ward boy or Ayah

Minimum 1 per ward/ floor

Eight standard completed

(OP/ward

142

H.4 Nurses:

5. Category: Nursing (As per Minimum standard of Hospital attached with colleges)

6. Minimum Qualifications: GNM or BSc or MSc Nursing

7. Registration: State Nursing Council of where hospital is located

8. Trained / skilled: Trained

(As per Minimum standard requirement of Hospital attached with colleges)

Nurses to Beds Ratio: 1 per 10 beds

H.5 Administrative staff: The number would vary as per requirement and may be outsourced.

Administrative staff

Sr. No

Nursing Staff

Min 10 bedded Hospital

11-25 bedded Hospital

26-50 bedded Hospital

51-100 bedded Hospital

100 & above bedded Hospital

.Staff Nurse

1 for every 10 beds in IPD and 2 for OPD attendance up to 150 patients and 1 extra each for additional 100 patients.

.Matron

–

Sl. no

Administrative staff

Min 10 bedded Hospital

11-25 bedded Hospital

26-50 bedded hospital

51-100 bedded hospital

101 & above bedded Hospital

.Office Superintendent/ Hospital Administrator

–

.Accountant

.Computer Operator

.Security Staff*

143

H.6. Miscellaneous staff

Sl. no

Administr ative staff

Qualification

Min 10 bedded Hospital

11-25 bedded Hospital

26-50 bedded hospital

51-100 bedded hospita l

101 & above bedded Hospital

Clerk for Billing

Minimum qualification- 12th Standard passed.

Cook

(if food is cooked in- house)

Experience of working in mass kitchen for at least 1 year at senior cook or at in charge level.

Optional

Driver (Only in case hospital has its own vehicle for patient or ambulance services)

Driver’s License for the category of vehicle With State Road Transport Office.

If driving an ambulance, specific training is required.

Optional

Electrician

If exists, Diploma in Electrical Engineering.

Optional

Housekeepi ng Staff

Ability to read national or local language

Kitchen Servant

(if food is cooked in- house)

–

As required

Maintenanc e person

If exists, Diploma in Electrical Engineering.

144

Peon

Eight standard completed

Plumber

–

10.

Sanitary Worker

–

11.

store keeper/ Manager

Minimum qualification- 12th Standard passed.

I. Drugs

This segment includes the minimum essential drug which needs to be maintained in the facility.

As per the publication “Essential Drug List – Siddha Medicine” by Department of AYUSH, March 2013, as and where applicable the drug list for treatment conditions to be maintained in all IPD.

J. Consumables

This includes the minimum quantity of the commonly used consumables in the facility which should be made available.

J.1 Surgical

S.No

Surgical Consumables

Absorbent cotton

Adhesive plaster

Bandage Roll

Biomedical waste colour coded covers

Caps & mask

Catguts of different sizes

Developer

Disp-Gown, Cap, Mask, Big Sheet, Draw Sheet & Gloves(for communicable diseases)

ECG Paper Roll , ECG Jelly, Tissue Paper

10.

Enema Can

11.

Ether Anesthetic 500ml

12.

Fixer

13.

Gamjee Pad and Rolls

14.

Gauze Roll

15.

Hypodermic Needle (Pkt. of 10 needle) No.19, 20, 21, 22, 23, 24, 25, 26

16.

Indicator tape for sterilization by pressure autoclave

145

17.

Isopropyl Alcohol swab

18.

IV Cannula (different sizes)

19.

Leg drape

20.

Non Sterile Surgical rubber gloves

21.

Scalp vein sets (Different Sizes)

22.

Shaving blade –packet of 5

23.

Sterile & non sterile Gloves of different sizes

24.

Sterile cotton, gamjee pads, gauze pieces

25.

Sterile disposable syringes

26.

Sterile Infusion sets(Plastic)

27.

Sterile Surgical rubber gloves

28.

Ultra Sound Jelly

29.

Ultrasound scan film

30.

Vicryl No.1

31.

X-Ray film , TLD card

32.

Xylocaine Jelly

J.2 Dressing Material

S.No

Dressing Material

Absorbent cotton

Adhesive plaster

Bandage Roll

Dressing Thylam (Eg. Mathan Thylam)

Gamjee Pad and Rolls

Gauze Roll

Ghada Cloth

Siddha Antiseptic cream (eg. V.Vennai)

Siddha Antiseptic solution (eg. Padikaraneer, Thiripala Kudineer, Neem, Turmeric).

10.

Sterile & non sterile Gloves of different sizes

11.

Sterile cotton, gamjee pads, gauze pieces

12.

Suture material (Eg. Black silk, Catguts)

13.

Wooden Splint

146

J.3 Disinfectants: As applicable in adequate quantity

S.No

Disinfectants

Formaldehyde solutions (1%–2%)

10.

Glutaraldehyde

11.

Hydrogen peroxide

12.

Hypochlorite 4%-6%

13.

Neem Solution

14.

Phenolic germicides

15.

Quaternary ammonium compounds

16.

Turmeric Solution

J.4 Tubing

S.No

Items

Connecting tubings for oxygen delivery

Foleys catheters

Nebilization Mask (Adult & Paed.)

10.

Oxygen catheters

11.

Oxygen masks (Adult & Paed.)

12.

Suction catheters

13.

Uro Bag

147

J.5 Linen

S. No

LINEN

MIN 10

11to25

26to50

51 to 100

101 & above

Abdominal Sheets for OT

As required

Apron for Cook

As required

Bed sheets (1:3)

150

300

600

Bedspreads (1:4)

150

200

300

Blankets

As required

Central Hole Sheet

As required

Curtain Clothes for Windows & Doors

As required

Doctors Overcoat

1 per Doctor

Draw Sheet (1:2)

100

200

300

Green sheet (Big) (MOT / Labour Room)

As required

Hospital Worker OT Coat

One Per Worker

Leggings

As required

Mackintosh

1 per Bed

Mats (Nylon)

As per requirement

Mattress(Foam) (Adult)

1 per Bed

Mattress(Foam) (Paediatric)

1 per Bed

Patient Gown (OT/Labour Ward)

As required

Perineal Sheets

As required

Pillow

10+5

25+10

50+20

100+30

200+50

Pillow Covers (1:3)

150

300

600

Table Cloth

As required

Towels

As required

Uniform / Apron

As required

148

J.6. Stationery for Hospitals

S.No

Items

29.

Consents Forms

30.

Continuation Sheets for IPD

31.

Death Certificate Books

32.

Diet Cards

33.

Diet Sheets

34.

Discharge cards

35.

Gynecological and Obst. Case sheets

36.

Indoor Admission Form & Case Sheets

37.

Intake Output Charts

38.

Investigation Requisition and Report Forms

39.

Nurses Report Register

40.

Nursing Monitoring Forms

41.

Pharmaco Vigilance Form

42.

Prognosis and Treatment Charts

43.

Referral Forms

44.

Registers – IPD Nominal

45.

Registers – Medicine Indent Register

46.

Sentinel Event Form

47.

Surgical Case Sheets

48.

Temperature Charts

J.7.Consumables for Karanool

S.No

Items

Achyranthes Powder (Nayuruvi Uppu)

Alternatively Karanool may be procured from reputed agencies

Barbour Thread No.20

Guggulu

Surgical Spirit

Turmeric Powder

149

J.8 Laboratory

S.No Items

1. Benedict’s reagent

2. Bilirubin reagent

3. Blood Sugar Kits for Semi-Auto Analyser

4. Cap & Mask

5. Disposable Syringes

6. Drabkins reagent

7. EDTA Vacutainers

8. ESR Disposable tubes

9. Gingely Oil

10. Gloves

11. Haematocrite Tubes

12. Haematology counter reagent

13. HbsAg Kits

14. HIV Kits

15. Hypo Solution

16. Lancet

17. Leishmen stain

18. Lipid Profile Kits

19. Malaria Kits

20. Microscope cover slips

21. Seedar wood Oil

22. Sodium Citrate Vacutainers

23. Surgical Spirit

24. Test Tubes

25. Tourniquet

26. Urea, Creatinine Kits

27. Xylene reagent Grade Water

28. Ziehl Neelson stain

29. Zinc Sulphate

150

J.9 Leech Therapy

ITEMS

Bandage Roll

Gauze Roll

Gloves

Turmeric

Tuber of Lotus

Tuber of Kotti

Leech

Storage Containers for leech

J.10 Suttigai

S.NO

ITEMS

Mud Pot

Tuber of Turmeric

151

K. Licenses

This includes the minimum statutory compliance applicable as per the central or state government along with licensing body.

Name of the Act

Department/ Area

Licensing body

Registration under Shops and Establishment Act

Organization

Jurisdictional Panchayat/ Mahanagarpalika/ Municipal Corporation

Authorities like Nagarpalika/ Municipality/

Registration under Clinical Establishment Act

Organization

Jurisdictional Panchayat/ Mahanagarpalika/ Municipal Corporation

Authorities like Nagarpalika/ Municipality/

AERB clearances for CT/ MRI/ X ray & Radiation

Imaging

Atomic Energy Regulatory Board

Agreement for Common Biomedical Waste Collection, Transportation, Treatment, Storage and Disposal Facility

Organization

Local Pollution Control Board

Registration under Air (prevention and control of pollution) Act, 1981.

Organization

Local Pollution Control Board

Approval of Radiation Safety Officer

Imaging

Atomic Energy Regulatory Board

Boiler license under Indian Boiler Act, 1923

Boiler

Concerned regulatory Body

Building Permit (From the Municipality).

To be obtained from

Jurisdictional Revenue Authorities like Panchayat/ Nagarpalika/ Mahanagarpalika/ Municipality/ Municipal Corporation

Certificate for Narcotics & Psychotropic Substances

Pharmacy and / Hospital

Drug Controller

Certificate of Registration under society act 1860

Organization

Registrar of societies/ Charity Commissioners office

10.

Certificate u/s 80-G of IT Act

Organization

If applicable.

11.

Class clearance certificate issued to manufacturer/ importer of mobile X ray equipment

Imaging

AERB Class Clearance issued to Manufacturer/ dealer of imaging equipment

12.

Commissioning approval of Linear Accelerator

Radiation Therapy

AERB

152

13.

ESIS registration in case of >20 employees

Organization

Employee State Insurance Company

14.

Excise permit to store Spirit.

Organization

Excise department

15.

Generator Exhaust air Quality Report

Generator

Authorized Air Testing Laboratory

16.

License to sale or distribute drugs Form 20, 21, 21C

Pharmacy

FDA

17.

License for lift

Lift

Mobile Electric Vehicles Department

18.

License to play music for public use

Organization

Indian

19.

No objection certificate from the Chief Fire Officer.

Organization

Fire Department

20.

Obtaining clearances for weighing equipments in all the hospital units under The Standards of Weights and Measures Act, 1976.

Weights and measures

Department of Weights and Measures

21.

Occupation Certificate

To be obtained from

Jurisdictional Revenue Authorities like Panchayat/ Nagarpalika/ Mahanagarpalika/ Municipality/ Municipal Corporation

22.

PNDT Act, 1996.

Sonography

Health Department of Regulatory Body assigned with the responsibility

23.

Registration of births and deaths Act, 1969.

Organization

Health Department of Regulatory Body assigned with the responsibility

24.

SMPV License for Storage of Liquid Oxygen, Form III (License to compressed gas in pressure vessel or vessels)

Medical Gases in Pressurized Vessels

Licensing Authority

25.

TAN Number

Organization

Income Tax Department

26.

PAN Number

Organization

Income Tax Department

27.

Vehicle Registration certificates for Ambulance

Ambulance and Vehicles owned by the organization

Road Traffic Authority

28.

Water Prevention and control of pollution Act

Organization

Pollution Control Board

153

L. Basic Processes

L.1 Registration (This will help in developing a database at State / Central level).

13. Name,

14. Unique Identification Number (If Adhaar available or Id assigned in the Hospital) 15. Age,

16. Gender ,

17. Address with PIN code, / District / State

18. Marital Status,

19. Contact Number,

20. Type of Diet (Veg, Non-veg),

21. OP/ IP Number,

22. Date & Time of visit for OP/ admission for IP,

23. Name of Treating Doctor

L.2 Assessment

20. Primary Complaint of the guest:

21. History of Primary Complaint:

22. History of Medication:

23. History of Implants/ Pacemaker/ Surgery:

24. Past History

25. History of allergies

26. Diet and Lifestyle History

27. Family History

28. Personal History

29. General Examination

30. Systemic Examination

31. Physical Examination

32. Envagai Thervu, Neerkuri, Neikuri, Thegam, Elu Udalkattugal, Uyir Thathukkal

(Vatham, Pitham, Kabam)

33. Pain Scoring

34. Nutritional Assessment

35. Diagnosis Provisional / Final

36. Preventive Aspects

37. Plan of Care

38. Treatment

L.3 Infection Control

6. Cleaning: to be done with defined solution with dilution as advised by the manufacturer. Defined schedule with full cleaning at least once a day.

7. Disinfectants: Defined solution with dilution as advised by the manufacturer. Defined schedule with full cleaning at least once a day.

8. Advisable to have designated Infection Control Officer for hospital more than 50 beds.

9. Advisable to have designated Infection Control Committee for hospital more than 50 beds.

10. Infection control activities should be monitoring by define method & schedule.

154

L.4 Safety considerations

(Surgical safety, infection control, biomedical waste, first aid & basic life support, disaster preparedness)

Following physical safety aspects shall be taken care in the hospital

1. AERB safety rules shall be followed in Radiology and other radiation areas.

2. All areas where a physical hazards may occur, like near DG set, transformer, Cylinder storage, electric panels, steep slope etc. shall be provided with safety

signage and safety instructions

3. All balconies and opening on higher floors shall have grills

4. All bottles containing acids or alkalis shall be stored on cupboards at height

below the shoulder level to prevent them from falling while taking out. It shall

never be stored on height above the head level

5. All electric panels shall be enclosed in insulated and nonflammable box and shall

be kept locked

6. All entry doors, windows and furniture shall be maintained in good maintained

condition

7. All equipments, furniture awaiting condemnation shall be stored in separate

condemnation area

8. All stretchers and wheelchairs shall have safety belts for fastening the patient

9. Anti-skid mats shall be placed on entrance of bathrooms

10. Boundary wall of the hospital’s campus shall be of sufficient height with metal

fencing on top. Entire boundary wall shall be kept in intact condition

11. Corridors and passages shall not be blocked by chairs, tables or equipments

12. Displays of ‘floor is wet’ or ‘under repair’ or similar precautions in required areas

and time shall be available with the hospital

13. Doors height shall be at least of 8 feet

14. Electric rooms shall not be used as store room or for any other purpose

15. Emergency exit routes shall be kept clear all the times

16. Hospitals ground shall be properly maintained. There shall be no openings, or

pits in the ground. The surfaces shall be kept even

17. Lab shall be provided with safety equipments like eye wash cups

18. Material safety data sheet shall be available for all hazardous materials

19. No door shall open towards public areas like crowded lobby etc. (the door shall

preferably open towards the inside of room)

20.No inflammable materials like, diesel, LPG, acids etc. shall be stored near

electrical panel

21.Personal protective gears shall be available everywhere and in adequate

quantity. These include gears like, gloves, masks, gowns, boots, caps, goggles etc. Earplugs shall be provided to staff in areas where there is continuous noise, like AC plant.

22. Protection from stray dogs and other animals shall be ensured in the hospital campus

23. Rubber matting shall be placed on the floors below electric panels

24. Seepage shall not be allowed in areas where electric panels or wires are present

25. Terrace should have side walls of at least 4 feet height

26. The beds shall have provision for providing side guardrails.

155

27.There should be no losing of electrical wiring. All electrical wiring shall be concealed and kept intact

6. Surgical safety

1. There are two independent identifiers for each patient. Name of patient with some other independent identifier.

a. the period before induction of anesthesia,

b. the period after induction and before surgical incision

c. the period during or immediately after wound closure but before

removing the patient from the operating room.

4. In each phase the checklist task must be completed before proceeding forward.

7. Infection control:

1. Biological safety assessment is done for all areas of patient care and risks defined for the same.

a. Needle Stick Injury and related Transmissions

b. Patient to staff, patient to patient and staff to patient risk of transmission

of diseases is addressed and preventive measures are instituted.

c. Procedure site and surgical site infections are monitored.

2. Preventive measures and remedies for correction are kept available wherever such risk exists.

3. Hand washing practices as per WHO recommended criteria are followed and monitored regularly.

4. Facility and consumables for hand washing are available tat convenient locations in the healthcare facility.

4. Biomedical waste:

1. Biomedical waste is collected, segregated, packed, transported and disposed according to the regulatory guidelines.

2. Biological Waste Management is monitored on regular basis.

3. Biomedical waste disposal is a part of infection control activities.

7. First aid & basic life support

156

1. At all times there is a staff member who is adequately qualified and is trained in giving at least Basic Life Support System.

2. Adequate qualifications will include qualified nurse or doctor from any specialization who has undergone training on Basic Life Support.

3. There will be a full resuscitation set maintained for use exclusively during such events, irrespective of existence of similar equipment anywhere else in the hospital.

8. Disaster preparedness: Yes for all hospitals of all sizes.

1. Healthcare organization must identify various possible disasters and prepare for

the same by stocking necessary consumables, training adequate staff and

conducting drills regularly.

2. Keeping equipment in a state of readiness for use during such events.

3. Separate stock is maintained as per the risk perceived for the anticipated disorder(s).

4. Keeping a back-up of consumables at all times in usable condition for use during disaster.

5. Personnel are trained for disaster management

6. Disaster drills are carried out at least once in six months for various disaster

anticipated.

7. Anticipated list of disasters can include and is not restricted to any of:

a. Fire

b. Terrorist attack

c. Invasion of swarms of insects and pests.

d. Earthquake.

e. Civil disorders effecting the Organization.

f. Sudden failure of supply of electricity. (Disaster)

7. Fire – Safety Measures

As for safety against fire accidents, fire extinguishers of various powder gas & water type have to be installed & maintained periodically. Fire alarm system equipments have to be fixed in inpatient department, OP Department Lab block & Pharmacy and kept in good condition so as to effectively use them in case of fire accident. All staff members should be given one day training on operation of Fire extinguisher annually.

M.1 Clinical Records (including consents)

Sr. No

Records

OPD/ IPD Records

Treatment Orders

Medication Records

Procedure Records

Nursing Monitoring Records

Nursing Treatment Records

157

Reports of investigations

Consents: General Consent at admission, Procedure consents

M.2 Discharge

2. Discharge Summary should have following details:

a. Primary data of Name, UID, Gender, Age, Address with PIN code, Marital

Status, Contact Number, Type of Diet (Veg, Non-veg), OP/ IP Number, Date of

visit for OP/ admission for IP, Treating Doctor, Discharge date & Reason

b. Primary Complaint of the guest

c. History of Primary Complaint:

d. History of allergies

e. Salient Examination Findings

f. Pain Relief Advice

g. Nutritional Advice

h. Diagnosis – Final

i. Preventive Aspects

j. Treatment Given

k. Details of procedures performed

l. Treatment advised

m. Contact number in case of emergency

158

Teaching Hospitals

All teaching hospitals should comply the notification of Central Council of Indian Medicine Notification, New Delhi Notification 13-2-2013 – Indian Medicine Central Council (Minimum standard Requirements of Siddha Colleges and attached hospitals) Regulations, 2013

159

N. References/Bibliography Reference

1. Essential Drug List – Siddha Medicine, Department of AYUSH, March 2013

2. Indian Medical Association – Government of India- Quality Council of India

Survey Report & Recommendations Of Clinical Establishments – 2013

3. The Clinical Establishments (Registration and Regulation) Act, 2010

4. Central Council of Indian Medicine Notification, New Delhi Notification 13-2-

2013 – Indian Medicine Central Council (Minimum standard Requirements of

Siddha Colleges and attached hospitals) Regulations, 2013

5. Central Council of Indian Medicine Notification, New Delhi Notification 2-5-2013

– Indian Medicine Central Council (Minimum standards of Education in Indian

Medicine) Amendment Regulations 2013.

6. National Accreditation Board for Hospitals & Healthcare Providers (NABH),

General Information Brochure,2010

7. WHO – Development of Standard Siddha Terminologies

8. Recommendations on Electronic Medical Records Standards in India – Ministry

of Health and Family Welfare, April 2013

O. Abbreviations

1. ATM- Aruvai &Thol Maruthuvam

2. B.S.M.S.- Bachelor of Siddha Medicine and Surgery 3. CR – Consultation Room

4. DS – Deputy Superintendent

5. FNA -Female Nursing Assistant

6. FSK -Furniture stock keeping

7. HS- Hospital Superintendent

8. IPD- In Patient Department

9. M.D(S)- Doctor of Medicine(Siddha)

10. MNA – Male Nursing Assistant

11. MSK – Medical stock keeping

12. Minor OT – Minor Operation Theatre. 13. MOT –Minor Operation Theatre

14. Min – Minimum

15. OPD- Out Patient Department

16. SPM- Sirappu Maruthuvam

17. SMM-Sool Magalir Maruthuvam

18. SR – Service Room

19. RMO-Residential Medical Officer

160

MINIMUM STANDARDS FOR

CLINICAL ESTABLISHMENTS OF

HOMOEOPATHY

161

CONTENTS

SL TITLE PAGE A Introduction 164

A.1 General 164

A.2 Scope 164

B. Functions 166

B.1 Core functions (Clinical services) 166

B.2 Auxiliary Functions (support services for ex – diagnostic) 167

C. Physical Facilities 169

C.1 Space requirement 169

C.1.1 Minimum area 169

C.1.2 Functional space 171

C.1.3 Dimensions of the sub areas 174

C.1.4 Basic signage 174

C.1.5 Others 175

C.2 Furniture & Fixtures 177

C.2.1 Furniture/Fixture Requirements 177

C.2.2 Sundry Articles 180

C.2.3 Others 180

C.3 Engineering Services Requirements 181

C.3.1 Electrical Requirements 181

C.3.2 Plumbing Requirements 181

C.3.3 Civil Requirements 182

C.3.4 HVAC / AC / Ventilation / Cross Ventilation Requirements 182

C.3.5 Others 182

C.4 Public Utilities 182

C.4.1 Potable drinking water 182

C.4.2 Sanitary Requirements 182

D. Equipment /instruments 183

D.1 Therapeutic equipment 183

D.2 Surgical equipment 185

D.3 Diagnostic equipment 187

D.4 Emergency equipment 189

D.5 Sterilizing Equipment 189

E. Manpower 190

E.1 Medical practitioners 191

E.2 Therapists 191

E.3 Paramedics 191

E.4 Nurses 193

E.5 Administrative staff 193

F. Drugs 194

162

F.1

Anaesthetic drugs

194

F.2

Emergency drugs

194

F.3

General Drugs

195

Consumables

196

G.1

Surgical

196

G.2

Dressing Material

196

G.3

Disinfectants

197

G.4

Tubing

197

G.5

Linen

197

G.6

Stationery

198

G.7

Adhesives and gels

198

G.8

Others

198

Licenses

199

Basic Processes

201

I.1

Registration

201

I.2

Assessment

201

I.3

Infection Control

201

I.4

Safety considerations

202

I.5

Clinical Treatment Records

204

I.6

Discharge

205

163

A Introduction

A.1 General

In India, unlike allopathic hospitals, stand alone homoeopathic hospitals are almost nonexistent. Homoeopathic hospitals are attached with homoeopathic teaching institutions in India. Individual private clinics and/or Government run homoeopathic dispensaries and polyclinics are situated as has been shown in the survey conducted by the India Medical Association. These homoeopathic teaching institutions along with the attached hospitals are guided by the Central Council of Homoeopathy Minimum Standards Requirement Act 2013. The Minimum standard requirement for different homoeopathic hospitals shall be, inter alia, as per the Central Council of Homoeopathy Minimum Standards Requirement Act 2013. Number of beds available in attached homoeopathic hospitals shall be proportionate to the intake capacity of the Homoeopathic College.

A.2 Scope

This includes the services being provided by the facility to which the standards will be applicable. Homoeopathic health care establishments shall be classified as under

1. Individual Homoeopathic Clinic,

2. 10 Bed Homoeopathic Hospital,

3. 25 bed Homoeopathic Hospital,

4. 50 Bed Homoeopathic Hospital,

5. 100 Bed Homoeopathic Hospital,

6. More than 100 Bed Homoeopathic Hospitals, and

7. Homoeopathic Teaching Hospitals.

These shall be within the ambit of the Clinical Establishments (Central Government) Rules 2012. The clinical establishment shall register, under the respective State Govt. or Union Territory Administration in compliance to the Clinical Establishments (Central Government) Rules 2012, through standard application form prior to their establishment. Respective State Govt. or Union Territory Administration shall provide the required registration and permission for continuation of the establishment on fulfillment of the terms and conditions as laid down in the Rules.

164

Type of Health Care Facility

Scope of Services

Clinic

Outdoor care facility managed by a single Homoeopathy medical practitioner or a group of Homoeopathy practitioners with or without a day care facility. No overnight stay or care is provided here. The average patient reporting to such clinic shall be up to 50 patients per day per clinic.

10 bed Homoeopathic Hospital

Health Care facility with 1 to 10 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Homoeopathy physician trained in the concerned system of medicine having graduate or preferably postgraduate qualifications.

11to25bed Homoeopathic Hospital

Health Care facility with 11 to 25 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Homoeopathy physician trained in the concerned system of medicine having graduate or preferably postgraduate qualifications.

26 to 50 Beds

Health Care facility with 26 to 50 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Homoeopathy physician trained in the concerned system of medicine having graduate or preferably postgraduate qualifications.

51 to 100 Beds

Health Care facility with 51 to 100 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Homoeopathy physician trained in the concerned system of medicine having graduate or preferably postgraduate qualifications.

More than 100 bed Homoeopathic Hospitals

Health Care facility with more than 100 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Homoeopathy physician trained in the concerned system of medicine having graduate or preferably postgraduate qualifications.

Teaching Homoeopathic Hospitals

Health Care facility provided through hospitals attached with homoeopathic medical colleges for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Homoeopathy physician and faculty members of the medical college trained in the concerned system of medicine having graduate or preferably postgraduate qualifications.

Homoeopathic hospitals having 20 beds and above shall be considered as teaching homoeopathy hospitals and shall be in compliance of the Homoeopathy Central Council (Minimum Standards Requirement of Homoeopathic Colleges and attached Hospitals) Regulations 2013, vide The Gazette of India, (Extra Ordinary) dated 08-03-013.

165

B. Functions

This section includes the basic services provided by facilities. It is subdivided into two parts B.1 Core functions (Clinical services)

(Clinics & Outdoor Patients facilities of health care organizations of 1 to 10, 11 to 25, 26 to 50, 51 to 100, more than 100 beds & teaching homoeopathic hospitals)

Upto10Bed

11to25bed

26 to 50 beds

51 to 100 beds

Teaching Hospitals

Minimum Clinical OPD Services to be provided

Organon of Medicine

Community Medicine

Homoeopathic Materia Medica

Surgery

Repertory;

Obstetrics & gynecology

Practice of Medicine

Pediatric

Pediatrics

Dental (optional)

Obstetrics & gynecology

Organon of Medicine

Homoeopathic Materia Medica

Repertory;

Homoeopathic pharmacy

Homoeopathic pharmacy;

Practices of Medicine

Practices of Medicine;

Pediatrics

Pediatrics;

Psychiatry

Indoor patients facilities

In-Patient Department of the Hospital shall have separate Male and Female wards. Distribution of beds shall be as under: –

i. General Medicine – 50% (for acute patients – 10% and for chronic patients 40%)

ii. Pediatrics – 10%

iii. Surgery – 20%

iv. Obstetrics & Gynecology – 20

166

The indoor department of the hospital shall have separate male and female wards and distribution of beds at the rate of 64 sq. feet (8 ft x 8 ft) area per bed per ward as under –

Upto10bed

11to25bed

26 to50bed

51 to100 bed

Teaching Hospitals

Minimum Clinical Services to be provided in IPD

Organon of Medicine

Community Medicine (optional)

Homoeopathic Materia Medica

Surgery

Repertory;

Obstetrics & gynecology

Practice of Medicine

Pediatric

Pediatrics

Dental

Obstetrics & gynecology

Organon of Medicine with Homoeopathic Philosophy;

Homoeopathic Materia Medica including applied aspects;

Repertory;

Homoeopathic pharmacy;

Practices of Medicine;

Psychiatry.

Operationalization of beds of Psychiatry ward shall be subjected to availability of full time psychiatrist and trained nurse required for the purpose.

B.2 Auxiliary Functions (support services for eg: diagnostics) (Central Laboratory for clinical diagnosis and investigations).

5. There shall be a central laboratory in the hospital complex with proper infrastructure and work force for carrying out routine, pathological, biochemical and hematological investigations on the patients referred from outdoor and indoor departments of the hospital.

6. There shall be a central imaging unit in the hospital complex with proper infrastructure and work force for carrying out routine, imaging investigations on the patients referred from outdoor and indoor departments of the hospital.

167

Support Services:

1. Accounting

2. Ambulance services

3. Billing

4. Dietary services/ Canteen

5. Essential commodities like water supply, electric supply etc.

6. Finance

7. Financial accounting and auditing

8. Housekeeping and Sanitation

9. Inventory Management

10. Laundry services

11. Medical records

12. Medicine preparation area

13. Medico legal records

14. Office Management (Provision should be made for computerized medical records

with anti-virus facilities whereas alternate records should also be maintained)

15. Personnel Department

16. Pharmacy/ dispensary

17. Purchase

18. Reception,

19. Security services

20. Stores

21. Waste management

168

C. Physical Facilities

C.1 Space requirement

This entails the minimum space required for carrying out the basic functions of the facility which includes:

C.1.1 Minimum area required for establishing the facility

Type of Health Care Organization

Requirements

Stand alone building

Part of another building

Minimum built up area

Clinic

As permitted Development control Floor Space Index, regulations, etc.

under rules, Local

150 sq feet per clinic with temporary partition for patient waiting.

1to10bed

Local

structures,

etc. will be followed.

regulations building occupancy,

350 square meters.

11to25

765 square meters.

26to50

1530 square meters.

51 to 100

3060 square meters.

Teaching Hospitals

5000 square meters.

169

11to25 bed

26to50 51to100 bed bed

100 200

200

350 500

350

750 2000

Optional (100)

100 100

30 30

50 50

Optional

30 30

Optional

50 50

45 45

55 55

765

1530 3060

SL No.

5 6 7 8 9 10

Break up of built up area

Minimum area in square meters

1 to 10 bed

Hospital Administration Block

Superintendent Room

Rooms for Senior Medical

Officer 20 300 Staff nurse

Description of the Rooms

Teaching Hospital

Reception & Registration Counters

Out Patient Departments Medicine

Obs & Gyn Pediatrics Dressing rooms Dispensary

Store

In Patient Department

General Medicine ward (male & female separate)

Pediatrics

Surgery ward (male & female separate)

Obstetrics & Gynaecology

Toilets and Bath rooms (male & female separate)

Doctors duty room

Nursing Station

Operation theater Unit Operation theater Preparation room

Post operative recovery room Space for sterile items

Labor room

Rooms for surgeon/obstetrician/Assistant

Nursing staff room

Physiotherapy & yoga Unit Central Clinical Laboratory Radiology & Sonology

50 500

200 3000

optional 250

30 50

30 150 Optional 100

Kitchen Optional 250

Medicine Stores

General Stores

Total

10 200

350 5000

170

C.1.2 Functional space: planning of the facility like reception area, waiting area etc.

25.Consultation & examination room

a. Minimum 10 ft. x 10 ft.

b. Consultation room should be adequate to accommodate:

i. Doctors table,

ii. Consultation chair, iii. Two stools/ chairs,

iv. Examination bed of the size 6 ft X 2.5 ft.,

v. Privacy screen around examination area while having free mobility

26.Pharmacy/Dispensary Room:

a. The pharmacy should be located in an area conveniently accessible.

b. Temperature & humidity to be maintained as per the requirement of the

stored medications.

c. The size should be adequate to contain 5 percent of the total clinical visits

to the OPD in one session for hospitals with more than 50 beds.

d. Pharmacy should have adequate medicine storage and dispensing facility

for indoor and outdoor patients.

e. In view of the alcohol use and storage in homoeopathic pharmacy, it

should be adequately equipped with fire safety norms.

27.Entrance hall with reception area, enquiry counter, cash counter and record area

a. Preferably 100 sq. ft per 25 beds

28. Waiting area in entire organization

a. Preferably 100 sq. ft per 25 beds i.e. 10% seats of average number of patients visiting daily to hospital.

b. Waiting hall shall have the facility for toilet and drinking water.

c. Information like hospital timings, dos and don’ts in the hospital, various types of services available and utility fees shall be displayed in the waiting

hall.

29.Kitchen area: Applicable only if food is cooked in the hospital. Providing food is mandatory for hospitals of size over 100 beds.

a. Kitchen area should be sufficient size to prepare food for inpatients as per diet advised by the physician

b. Kitchen layout and functioning should follow the flow of materials as: EntrywashedcuttingcookingloadingTo Serve

c. Utensil washing area is separate from the cooking area.

30.Medicine preparation area: Applicable for hospitals of size over 50 beds.

a. Preparation area should be of minimum 50 sq. ft: only if medications are prepared in the hospital.

31.Medical Stores specs:

a. The medical store may be part of pharmacy or separate and secured.

b. Area should be clean, well ventilated, well lit, without any dampness or

fungal growth on walls.

171

c. In view of the alcohol use and storage in homoeopathic pharmacy, it should be adequately equipped with fire safety norms.

d. Homoeopathy medicines shall be stored separately as per the HPI guidelines in a separate store (other than general store).

32.RMO Quarters:

33.Nursing station/ duty room (Nurses):

a. One nursing station/room per 15 beds.

b. Applicable for clinics only if there is a day care ward.

c. Nursing stations should be spacious enough to accommodate a table,

requisite chairs, working platform, medicine racks, a work counter, sinks,

dress table, screen, pedal operated trash bins.

d. Station should accommodate all nurses on duty at any time.

34.Clinical laboratory specifications:

a. Laboratory services can be outsourced or can be optional for hospitals upto 100 beds.

b. Laboratory services are mandatory for hospitals above 100 beds for quick diagnosis of blood, urine, etc., a small sample collection room facility shall be provided.

c. Separate Reporting Room for doctors should be there.

d. Must have proper facility for management biomedical waste.

35.Radiology section:

Role of imaging department should be radio-diagnosis and ultrasound along with hire facilities depending on the bed strength.

a. The department should be located at a place which is accessible to both OPD and wards and also to operation theatre department.

b. The size of the room should depend on the type of instrument installed.

c. It should confirm to AERB requirements.

d. The room should have a sub-waiting area with toilet facility and a change

room facility, if required.

e. Film developing and processing (dark room) shall be provided in the

department for loading, unloading, developing and processing of X-ray

films.

f. Separate Reporting Room for doctors should be provided.

36.Laundry (optional)

a. Laundry services can be outsourced or can be optional.

b. If it is provided in house, it should have necessary facilities for drying,

pressing and cleaned linens.

c. If outsourced, disinfection of linen is carried out by the hospital before

handing over the linen to the out-sourced organization.

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37.Emergency Room specifications:

a. Emergency room should be spacious enough to accommodate a table, requisite chairs, working platform, medicine racks, a work counter, sinks, dress table, screen, pedal operated trash bins.

b. Station should accommodate all nurses & doctors on duty at any time.

c. Room should allow free movement of wheel chair or trolley.

d. Emergency Room should preferably have different entry than the hospital

entry.

e. Access to Emergency Room should have a ramp for wheel chairs and

stretchers.

38. House-Keeping:

a. Housekeeping services should be made available for effective cleanliness. b. Housekeeping services can be outsourced.

c. Designated areas within functional areas for housekeeping materials has

to be in hospital more than 50 beds

39.Security Services:

a. There is a designated location for each security staff on duty.

40.Medical record-room:

a. Medical record-room should be of adequate size as per the load of the documents of the hospital.

b. Tamperproof material and locking facility Cabinets/ cupboards/ Boxes will be used.

c. Fire extinguishers of correct type should be made available nearby all locations.

41.Store rooms:

a. Store room should be lockable & of adequate size with exhaust fan.

b. Area should be clean, well ventilated, well lit, without any dampness or

fungal growth on walls.

42. Wards:

b. The ward planning will address minimization of the work for the nursing staff and shall provide basic amenities to the patients located within an area or unit.

c. Ward unit will include nursing station, preferably a treatment/ procedure room, nursing store and toilets as per the norms.

d. At the minimum one nursing station per ward of upto 45 beds will be provided.

e. There should be minimum 70 ft area per bed with 7 feet distance between the mid-points of adjoining beds and at least 3 feet distance between the beds and atleast 8” distance between the bed and the wall.

173

f. Width of the door to be at least 4 feet.

g. Permanent, semi-permanent or temporary partition should be present

between two beds.

h. Ward store area with lockable wall or steel cupboard(s).

43.Duty rooms for doctors

a. To accommodate 1 bed of 6 feet X 3 feet and a side table.

b. Separate beds if sharing for same gender.

c. Separate rooms for separate genders will be provided.

44.Duty rooms for nurses:

a. To accommodate 1 bed of 6 feet X 3 feet and a side table.

b. Separate beds if sharing for same gender.

c. Separate rooms for separate genders will be provided.

45.Dirty utility room:

a. Separate area of minimum 15 sq. feet.

C.1.3 Dimensions of the sub areas of the facility, including the flow of the processes which in turn will give a layout of the department /unit.

Specifications of the Operation Theater/ Minor OT

(if surgical services are provided in hospital having more than 100 beds):

1. OT/ procedure room should have sterile zone of at least 10 ft X 10 ft; Size is exclusive of clean zone, independent enclosure to accommodate equipment & maintaining adequate privacy.

2. OT is mandatory if surgical procedures are provided in any hospital.

3. Waiting area: Adequate number of seats/ chairs with respect to the bed strength

and load of the patients will be provided.

4. Consultation room with examination room: adequate to accommodate Doctors

table, consultation chair, two stools/ chairs, examination bed of minimum size of 6

ft. X 2.5 ft., privacy screen around examination area.

5. Sterilization room: adequate to accommodate sterilization equipment & sterilized

material.

6. Separate Recovery room for regimental therapy is mandatory only in health care

units which provide stand-alone services. Otherwise ward beds of the facility can be

utilized.

7. Separate disposal zone for storage of waste as per bio-medical waste management

rules.

C.1.4 Basic signage

1. A signage within or outside the facility should be made available containing the following information. The information shall be in compliance of the Clinical Establishments (Central Govt.) Rules 2012.

2. All signage meant for patients and visitors shall be bilingual – Local language and Hindi / English.

174

C.1.4.1 Name of the care provider with registration number,

1. Name of organization.

2. Display of Registration under Clinical Establishments Act.

C.1.4.2 Fee structure,

1. Display of tariff list at OPD, Emergency etc.

2. Display of citizen charter in OPD and emergency

C.1.4.3 Timings of the facility

1. Display of OPD timings with names and respective specializations of consultants in OPD.

C.1.4.4 Services provided

1. Directional signage at main entrance towards emergency and OPD

2. Directional signage for patients for utilities and conveniences like toilets,

drinking water, telephone booths, shops

3. Directional signage within the hospital building for all departments within

the building

4. Display of department / area name on the entrance of each area / room /

counter

5. Display of hospital layout at various entrances in the hospital

6. Display of hospital’s scope of services at OPD, Emergency and at Campus

entrance

7. Floor Plan With Location Of Departments

8. Plan of Facility

9. usages: departments, OPD & IP room & wards, waiting areas,

C.1.5 Others

1. Display of all radiation hazard signage in radiation areas (if applicable).

2. Display of Biomedical waste segregation at all location where BMW bins are

kept

3. Display of danger signage at all electric panels and other dangerous areas

4. Display of General instructions like ‘No Smoking’, ‘Keep Silence’, ‘Use

dustbin’, etc. at various patient and visitor areas in the hospital

5. Display of hand–washing techniques compliant with WHO guidelines at all

hand wash basins

6. Display of how to use fire extinguisher at all point where fire extinguisher is

installed

7. Display of important phone contact numbers of hospital authorities

8. Displays required by regulations like PCPNDT, Lifts, Fire, etc.

9. Display of Material Safety Data Sheet at all locations where Hazardous

Materials are stored

10. Display of patient rights and responsibilities in OPD, emergency and wards

11. Display of safety instructions in areas where any kind of safety hazard may

be expected. This includes areas like transformers, Cylinder storage, LPG

storage etc.

12.Emergency exit signage (preferably in auto illumination material, like

radium)

13. Fire Protection

14. Hazards- electrical, fall, pipe locations, prohibited areas

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15. Notice board for general information to staff 16. Notice board in front of all OPD and Wards. 17. Notice board in Operation theatre

18. Routes for all areas

19. Signage for parking. (Signage for ambulance parking shall be separately mentioned)

20. Safety signage will be displays as per the requirements of respective Indian Standards: Ex. Fire Protection Safety Signs IS 12349:1988

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C.2 Furniture & Fixtures:

This will entail the details about the furniture and sundry items commensurate to the service delivery requirements.

C.2.1 Furniture/Fixture Requirements:

1: Furniture/Fixture Requirements for Outpatient Department (OPD): (PER CONSULTATION ROOM)

Name of the Equipment

1to10 bed

11to25 bed

26to50 bed

51 to 100 bed

Teaching Hospital

Room with well-lighted and ventilated and equipped with a chair and a table for doctor

X-ray viewer

Two chairs for patients & attendants

1 set

An examination table of 6 ft. X 2.5 ft. With privacy screen

Blood pressure apparatus,

Stethoscope

Torch

Thermometer

Weighing machine

Essential diagnostic tools required for examination of patients as per the scope of services offered by the hospital.

As per requirement

Light source which gives light colour and temperature similar to solar light, Light intensity of at least 500 lux at the point of examination.

As per requirement

Computers, (if required)

1 per consultation room

Telephone equipment

As per requirement

Air conditioning

As per requirement

Adequate lockable storage space

As per requirement

Foot stools

1 per consultation room

177

2: Furniture/Fixture Requirements for In-Patient department (IPD):

1to10 bed

11to25 bed

26to50 bed

51 to 100 bed

Teaching Hospital

1 per floor

1 per 5 patients

1 per ward or full length curtains between the beds

As per requirement

1 per ward

As needed

1 per floor

ABC 1 per ward/ floor based on layout

1 Per Area/ Ward

1 per ward

100

300

500

2 per ward

100

150

2 per ward

Adequate

One per procedure roo

1 per ward

20% of total beds

1 per bed

1 per ward/ floor a per the profile of patients & layout of facility

Sr. Name of the Equipment No.

Ade1q.uate wall or steel Cupboards

2. Arm Board Adult

3. Back rest

4. Bain Marie trolley stainless steel 1

per floor

5. Bed side cabinets

6. Bed side Screen

7. Bucket Plastic

8. Ceiling Fans

9. Clock

10. Containers for kitchen

11. Doctor’s chair for OP & ward,

12. Doctor’s or Office table

13. Dressing trolley-1 per floor/ ward

depending on layout

14. Dust bins in each ward & consultation

room

15. Duty table for nurses

16. Emergency resuscitation kit

17. Enema Set

18. Fire extinguisher –

19. Foot stools

20. Fridge

21. Heavy duty Torch light

22. Hospital Cots

23. Hospital Cots Pediatric

24. Hot Water Bags

25. Ice bags

26. Hot Water geyser

27. I V Stands – 2 per 10 beds

28. Intercom System

29. Kidney Trays1 per 5 beds

30. Kitchen utensils

31. Massage table of 7ft. x 2.5ft (wood or

fiber) if service is provided

32. Medicine trolley

33. Office chairs

34. Office Table

35. patient Beds with side rails

36. Patient call Bell System

37. Patient locker

38. Patients examination table– 1 per ward/ floor a per the profile of patients & layout of facility

178

39.

Patients side table

1 per bed

40.

Pediatric cots with railings as per scope of services

as per scope of services

41.

Steel or Wooden cup board

42.

Steel rack

43.

Stool 1Per Bed

44.

Stools revolving – 1 per ward

2 per ward

45.

Stretcher/ Patient trolley – 1 per ward

1 per ward

46.

Urinal Male and Female

100

150

47.

waiting chairs / benches for patients relatives

50% of the bed strength

48.

Weighing Machine

1 per ward

49.

Wheel chair

2 per 50 beds

50.

X-ray viewer

one per ward

3: Furniture/Fixture Requirements

Name of the Equipment

1to10 bed

11to25 bed

26to50 bed

51 to 100 bed

Teaching Hospital

Arm chair

One per service room

Examination table

Minimum 1

Focus lamp

Minimum 1 per service room

Footstool

One per service room

Gas/Stove

One per service room

Good light source

Minimum 1 per service room

hamox stretchers / Stretchers with wheels

One per service room

Heating facilities

One per service room

Hot water bath

One per service room

IV stands

One per service room

OT table / Lithotomy Table with Side Railings

Minimum one

Plastic aprons, gloves and mask

One per service room

Revolving stools

Minimum 1 per service room

Stool

One per service room

Sufficient light and ventilation

As per requirement

Surgical trolley

Minimum 1

Torch

Minimum 1 per service room

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Wheel chairs

One per service room

C.2.2 Sundry Articles Requirement

Furniture/Fixture Requirements

Sr. No.

Name of the Equipment

1to10 bed

11to25bed

26to50 bed

51 to 100 bed

Teaching Hospital

Air conditioners Central A/C for OT

Optional

Minimum 1

Ambulance

Optional

Minimum 1

Ceiling / wall Fans

As needed

Clock

1 per ward

Computer with modem with UPS, printer with internet connection

As needed

Coolers

As needed

Drinking Water purifier

As needed

Emergency lamp

2 Per Area/ Ward

Emergency trauma set

2 per ward

10.

Exhaust Fan

As needed

11.

Fire extinguishers

As needed

12.

Geyser

1 per ward

13.

Refrigerator

1 per ward

14.

Storage Geyser

1 per ward

15.

Tables & Chairs

As needed

16.

Telephone/ cell phone

1 per ward

17.

Tube lights

As needed

18.

Vacuum cleaner

As needed

C.2.3 Others

Furniture/Fixture Requirements Administration

Sr. No.

Name of the Equipment

1to10 bed

11to25 bed

26to50 bed

51 to 100 bed

Teaching Hospital

Computer with Modem 1.

with UPS, Printer with Internet Connection

As needed

Photocopier Machine

As needed

1 per ward

Intercom (10 lines)

As needed

Fax Machine

–

As needed

Telephone

One per organization

Two per organizati on

Public Address System

–

Covering Indoor and OPD Areas

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C. 3 Engineering Services Requirements

This will include detailed information about basic requirements including

C.3.1 Electrical Requirements

1. At least 3 hours backup or generator for critical areas

2. Primary electrical Supply is available as provided by the local utility

provider. Lighting back up for at least 1 hour covering all functional areas

must be available during the functioning time.

3. Primary electrical Supply as supplied by utility provider. Emergency backup

for at least 3 hours backup for electricity & for lighting and critical equipment must be available during the functioning time. Take over time must be less than 30 seconds. Electric supply to lighting will be backed up with UPS/ Inverter/ Battery.

4. The illumination in the hospital is provided as per the prescribed standards.

5. Shadow less lights should be provided in operation theatres and delivery

rooms.

6. Emergency portable light units should be provided in the wards and

departments.

C.3.2 Plumbing Requirements Number of Wash basins

i. 1 for every 20 persons or part there

ii. Doctor, staff, patients and visitors have an access to wash basin(s) 1

for every 50 persons or part there.

iii. Dirty utility & surgical / procedural hand wash basin will be separate

from general use & one each.

Number of Water closets

iii. 1 for every 20 beds or part thereof.

iv. Doctor, staff, patients and visitors have an access to wash closet(s) 20

beds or part thereof.

For in-patient department

a. No. of Wash basins

i. 1 for every 12 beds or part thereof

ii. Doctor, staff, patients and visitors have an access to wash basin(s);

iii. Procedure hand wash basins are separate and located close to procedure

area. 1 for every 12 beds or part thereof.

b. No. of Water closets

i. 1 for every 6 beds or part thereof

ii. Separate water closets are available for use for outpatient

and in-patient areas.

iii. For in-patient areas the water closets are provided in the

ratio of 1 per 6 beds and are located close to patient care

areas.

c. No. of bathrooms

d. WC

i. Minimum 1 bathroom per 6 beds/ one for each ward rooms

ii. Minimum 1 bathroom per 6 beds/ one for each therapy

rooms

181

i. Minimum 1 WC per 6 beds/ one for each Male & Female wards ii. Average size of toilet : 810 mm X 1800mm with grab bars

iii. Minimum 1 WC per 6 beds/ one for each Male & Female wards

iv. At least one wheel chair friendly toilet of dimensions 2200mm X

1800mm must be provided.

C.3.3 Civil Requirements

1. Space between 2 rows of beds in a ward should be minimum 5 ft.

2. Distance between 2 beds should be minimum 3.5 ft. if more than one bed is present 3. If clinic has beds then: measured between the facing borders of adjoining beds

there shall be at least 3 feet of distance if the beds are mobile and provided with

functional wheels and at least 4 feet if beds do not have functional wheels. 4. If there are no beds then this requirement is not applicable.

5. Size of hospital bed should be minimum 6’ x 3’

6. Area per bed should be Minimum 50 sq. ft. / bed

C.3.4 HVAC / AC / Ventilation / Cross Ventilation Requirements

1. Air-conditioning and Room Heating in operation theatre and neo-natal units should be provided.

2. The ventilation in the hospital may be achieved by either natural supply or by mechanical exhaust of air.

3. Cross ventilation/ Mechanical ventilation by fans and or exhausts to achieve comfortable environment without noxious odours.

C.3.5 Others

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

C.4 Public Utilities

C.4.1 Safe drinking water

1. Round the clock availability of safe drinking water for patients, staff and visitors.

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

C.4.2 Sanitary Requirements

1. Arrangement should be made for round the clock piped water supply along with an overhead water storage tank with pumping and boosting arrangements.

2. Approximately 10000 liters of potable water per day is required for a 100 bedded hospital.

3. Separate provision for firefighting should be available.

4. Water softening plant should be considered where hardness of water is a

major problem.

182

Drainage and Sanitation

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

Waste Disposal System: As Rules, 2016

per the Bio-Medical Waste Management

D. Equipments /instruments

This includes the type, number, minimum specification & functionality of equipments required in the facility under the following headings

D.1 Therapeutic equipments

1: Outpatient Department (OPD)

1: Equipment /Instruments Requirements for Outpatient department (OPD) (PER CONSULTATION ROOM)

Sr. No.

Name of the Equipment

Clinic

1to10 bed

11to25 bed

26to50 bed

51 to 100 bed

Teaching Hospital

A chair and a table for doctor

X-ray viewer

An examination table of 6 ft. X 2.5 ft. with privacy screen

Blood pressure apparatus

Stethoscope

Torch

Thermometer

Weighing machine.

Essential diagnostic tools required for examination of patients as per the scope of services offered by the hospital.

As per requirement

10.

Light source which gives light colour and temperature similar to solar light,

Light intensity of at least 500 lux at the point of examination.

As per requirement

11.

ENT SET

183

2: In-Patient department (IPD)

2:Equipments /instruments for In-Patient department (IPD):

Sr. Name of the Equipment No.

Autoclave Drums Back rest

Bain marie trolley stainless steel :1 per floor Bed pans:

1 per 5 patients Biomedical waste colour coded bins

Cheatle forceps assorted sizes

Clock

10. Containers for kitchen

11. Dressing trolley

12. Dust bins in each ward & consultation room

13. Emergency resuscitation

kit

14. Enema Set

15. Fridge

16. Heavy duty Torch light –

1 per ward

17. Hot Water Bags :

2 per ward

18. IVStands-2per10beds

19. Infra-Red lamp

20. Instrument tray –

minimum 1 per ward

21. Instrument trolley – 1 per

ward

22. Intercom System

23. Kidney Trays-1 per 5 beds

24. Medicine trolley

25. Needle cutter – 3 per ward

26. Non mercury Thermometer clinical – 1

per ward

27. O2 cylinder with spanner

– 1 per ward

28. Patients examination

table– 1 per ward/ floor a per the profile of patients & layout of facility

29. Sphygmomanometers- Stand Type 1& Portable

(aneroid or Digital) Type

X 1 – 1 per ward

30. Stretcher/ Patient trolley

1to10bed

11to25bed

26to50 bed

51 to 100 bed

Teaching hospital

100

200

One set each per floor

1 per ward

As required

1 per floor/ ward depending on layout

1 per ward

1 per floor

As required

1 per ward

As required

1 per ward

1 per floor

2 per ward

As required

2 per 10 beds

As required

1 per ward

minimum 1 per ward

2 per ward

minimum 1 per ward

As required

2 per 10 beds

1 per 5 beds

minimum 1 per ward

3 per ward

1 per ward

Ambu bags

2. Arm Board Adult

6. 7. 8. 9.

184

– 1 per ward

31.

Weighing Machine – 1 per ward

1 per ward

32.

X-ray viewer – one per ward

1 per ward

D.2 Surgical equipment Sr. No.

2. 3.

7. 8.

9. 10. 11. 12. 13. 14.

15.

16. 17. 18. 19. 20. 21. 22.

23. 24.

25. 26. 27.

28. 29. 30.

31. 32.

1: Operation Theater 1:Equipment Requirements for Operation Theater

Name of the Equipment

Auto Clave HP Vertical (2 bin)

Bladder sound (Urethral

dilators) of different sizes

11to25 bed

26to50 bed

51 to 100 bed

Teaching hospital

Anterior vaginal wall

Adequate

retractor

Adequate

Artery forceps

Autoclave equipment for sterilization/Sterilizer

Crash Cart with lifesaving

drugs and Resuscitation Kit

Cusco’s Speculum

Diathermy Machine (Electric Cautery)

Focus lamp Ordinary

As needed

Disposable syringes (5-10cc)

As needed

Enema Pot

As needed

Foley’s Catheter

General Surgical Instrument Set Piles, Fistula, Fissure

Formaline dispenser

Instrument Trays of various Sizes

Adequate

Knife and scissor1 each

As needed

Instrument Trolley

IV stands

As needed

Kidney tray

As needed

Magill’s forceps (two sizes)

Adequate

L. P. Tray

Adequate

Metallic or disposable insemination cannula

Adequate

Operation table Hydraulic Minor with stand

OT Spot light (Shadow less ceiling fitted/ stand mounted)

Shadow less lamp ceiling type major / minor

Sims speculum in small, medium & large size

Oxygen Cylinder

Plastic aprons, gloves and mask

Adequate

Oxygen Mask with Circuit

Adequate

Shadow less Lamp stand model

Adequate

Sphygmomanometer

Sterile cotton

As needed

185

33.

Sterile gloves

As needed

34.

Steriliser Small (Instruments)

As needed

35.

Sterilizer big (Instrument)

As needed

36.

Sterilizer Medium (Instrument)

37.

Stethoscope

38.

Suction Apparatus – Electrical

39.

Suturing Set

40.

Swab holders

41.

Thermometer

42.

Tongue depressors

43.

Toothed forceps

44.

two long (8 inch)& two short (6 inch) Artery forceps

45.

two Uterine sound

46.

Urethral Dilator Set

47.

Vaginal Examination set

48.

Vulsellum

1*: this is the minimum number required. 2: Anesthesia

Equipment Requirements for Anesthesia

Sr. No.

Name of the Equipment

11to25bed

26to50 bed

51 to 100 bed

Teaching hospital

Airway female & male

Adequate

Anesthesia Trolley / Boyle’s Apparatus

Minimum 1 if anesthesia is given

Anesthetic- laryngoscope Magill’s with four blades

CO2 cylinder for laparoscope

Connector set of six for ETT

Defibrillator/ AED

Endotracheal tube sets

Magill’s forceps (two sizes)

Mouth prop

10.

Multi-parameter Monitor

11.

N2O Cylinder for Boyles

12.

O2 cylinder for Boyles

13.

Tongue depressors

Adequate

14.

Tubes connecting for ETT

Adequate

*minimum number required

186

D.3 Diagnostic equipment

1: Imaging Equipment

1. Imaging Equipment

Sr. No.

Name of the Equipment

11to25bed

26to50 bed

51 to 100 bed

Teaching hospital

300 M.A. X-ray machine

Optional

Ultra Sonogram (Obs. & Gyne. department should be having a separate ultra-sound machine of its own)

Optional

Minimum 1

Echocardiogram

Optional

If X-Ray machine exists, there should be a minimum of one of each of the following items:

X-ray developing tank

Safe light X-ray dark room

Cassettes X-ray

Lead apron

Intensifying screen X-ray

Thyroid shield

10.

TLD batches

11.

Gonadal guard

12.

X-ray lobby single

187

* is the minimum number required

2: Laboratory Equipments

Sr. No.

Name of the Equipment

11to25bed

26to50 bed

51 to 100 bed

Teaching hospital

Alarm clock

1 Per Area/ Ward

Automatic cell counter

Optional

Auto analyzer/ Semi auto analyzer

Optional

Binocular Microscope

Chemical Balances

Counting chamber

Electric Colorimeter

Electric centrifuge, table top

ESR stand with tubes

10.

flame photometer

11.

Glucometer

1 Per Area/ Ward

12.

Haemoglobinometer

13.

Hot air oven

As needed

14.

Hot plates

As needed

15.

Lab Incubator

As needed

16.

Laboratory Auto Claves

As needed

17.

Micro pipette of different volumes

As needed

18.

PH meter

As needed

19.

Refrigerator

20.

Rotor / Shaker

21.

Simple balances

22.

Spirit lamp

23.

TCDC count apparatus

As needed

24.

Test tube holders

As needed

25.

Test tube rack

As needed

26.

Test tube stands

As needed

27.

Timer stop watch

As needed

28.

Water bath

As needed

188

D.4 Emergency equipments

Sr. No.

Name of the Equipment

11to25 bed

26to50 bed

51 to 100 bed

Teaching hospital

Emergency equipment box for first aid & BLSS

Minimum 1

Crash-Card trolley:1

Minimum 1

Portable defibrillator:1

Optional

Minimum 1

Disposable syringes

As needed

Ambu Bag:1

Minimum 1

Laryngoscope with cell

Minimum 1

Sealed battery cell

Minimum 1

Endotracheal tubes

As needed

Monitor

As needed

D.5 Sterilizing Equipments

Essential Drugs List –

The essential drug list for all the Homoeopathic clinical Establishments established under the Clinical Establishments Rules 2012 (Central Govt.) shall be in compliance of the EDL – Homoeopathy, March 2013, Dept. of AYUSH, Govt. of India.

Sterilizing Equipments

Sr. No.

Name of the Equipment

1to10bed

11to25 bed

26to50 bed

51 to 100 bed

Teaching hospital

Auto Clave HP Vertical (2 bin)

As needed

Minimum 1

Autoclave equipment (drums or trays) for sterilization/Sterilizer

Adequate

189

E. Manpower

This includes the Designation, minimum qualification & number of people required in the facility.

Minimum strength of staff of hospital attached to a homoeopathic college

No Name of the Post

1 Medical Superintendent

2 Dy. Medical Superintendent

2 Senior Medical officer

3 Medical Officer

4 Resident Medical Officer

5 Surgeon (General Surgery)**

6 Anesthetist*

7 Obstetrician/Gynaecologist**

8 Radiologist*

9 Pathologist/ Biochemist**

10 House Physician (Resident)***

11 Dispenser

12 Laboratory Technician

13 X-ray Technician/Radiographer

14Dresser

15 X-ray Attendant

16 Nursing Staff In-charge

17 Nursing Staff

18 Ward Boys/Ayas

19 Store Keeper

For For For For 51 to

20 25 50 100 beds beds beds beds

For More 100 than to 200 200 beds beds

1 1 2 3 3 5 5 7 3 5 2 2 1 1

2 2 1 1

3 5 12 20 5 8 5 7 3 5

1 1

2 2

1 1

On On Call Call

1 1

On On Call Call

1 1

2 2

1 1

2 4

2 2

1 1

On On Call Call

1 1

On On Call Call

1 2 5 8 2 3 1 2

On On Call Call

1 1 111135

On On 1 1 Call Call

1 1 1 1 2 3 7 9 3 4 7 9 1 1 1 1

3 3

3 5 12 15 15 18 3 3

190

Registration Clerk/Telephone Operator

21 Yoga Expert

22 Physiotherapist

23 Dietician (Part Time)

On Call

Every Homoeopathic Hospital shall engage adequate secretarial and Accounts staff for running the hospital smoothly.

Auxiliary staff like Lab Attendant, Dark Room Attendant shall be as per requirement.

The College and Hospital authorities shall make arrangements either by adequate staff of its own or through a contractor for looking after the jobs like cleanliness, laundry, hospital catering, gardening and watch and ward duties in the premises of the hospital.

Hospital reception, Out-Patient Department registration, In-Patient

27 Department registration, Medical record room, Accounts section shall be

properly manned and preferably computerised.

E.1 Medical practitioners

5. Category: Doctors

6. Minimum Qualifications: Degree/ Post Graduate Degree from recognized university by

Central of Homoeopathy

7. Registration: (if applicable): with State or central council of Homoeopathy

8. Trained / skilled: Trained

E.2 Therapists:

9. Category: Therapists:

10. Minimum Qualifications (5 1⁄2 years BHMS Degree from recognized University

by Central Council of Homoeopathy)

11.Registration with the Central Council of Homoeopathy (if applicable): State

Board /council of Homoeopathy 12.Trained / skilled: Trained

E.3 Paramedics

9. Category: Paramedics

10. Minimum Qualifications (diploma/degree from recognized university by Central

Government or State government of Indian Medicine.)

11. Registration with the concerned council(if applicable): state or central council of

Indian Medicine

12. Trained / skilled: Trained

191

Sr. no

Paramedics

Minimum qualification

1to10 bed

11to25 bed

26to50 bed

51 to 100 bed

Teaching hospital

Clerk for Billing

Minimum qualification- 12th Standard passed.

Cook

(if food is cooked in-house)

Experience of working in mass kitchen for at least 1 year at senior cook or at in charge level.

As per requirement

Driver (Only in case hospital has its own vehicle for patient or ambulance services)

Driver’s License for the category of vehicle

With State Road Transport Office.

If driving an ambulance, specific training is required.

As per requirement

ECG Technician (if ECG services are provided in- house)

1 year experience of taking ECG

–

Electrician

If exists, Diploma in Electrical Engineering

–

Hospital worker (OP/ward +OT)

Eight standard complete

Housekeeping Staff

Ability to read national or local language

As per requirement

Kitchen Servant (if food is cooked in-house)

–

As per requirement

Laboratory Attendant (Hospital Worker) (if lab is in-house)

Ability to read national or local language

10.

Laboratory Technician (if Lab is in- house)

Qualified Laboratory Technician

11.

Maintenance person

If exists, Diploma in Electrical Engineering

12.

Medical Records Officer / Technician

Minimum qualification- 12th Standard passed

13.

OT Assistant (if surgical services are provided)

Minimum qualification- 12th Standard passed

14.

Peon

Eight standard completed

15.

Pharmacist

(if pharmacy is in- house)

Diploma in Homeopathy Pharmacy (D.Pharma) Bachelor in Homeopathy Pharmacy (B.Pharma) Master in Homeopathy Pharmacy (M.Pharma)

–

16.

Physiotherapist

Qualified PT

192

17.

Plumber

–

18.

Radiographer (if Imaging is in- house)

Qualified Radiographer

19.

Sanitary Worker

–

20.

store keeper/ Manager

Minimum qualification- 12th Standard passed

21.

Therapy Attendant Minimum 1

Eight standard completed

As per requirement

22.

Ward Ayah Minimum 1 per ward/ floor

Eight standard completed

As per requirement

23.

Ward boy Minimum 1 per ward/ floor

Eight standard completed

As per requirement

24.

Dispenser

Eight standard completed

–

25.

Dresser

Eight standard completed

–

E.4 Nurses: Nurses to Beds Ratio: 1 per 10 beds

9. Category: Nursing

10. Minimum Qualifications: GNM or BSc or MSc Nursing

11. Registration: State Nursing Council of where hospital is located 12. Trained / skilled: Trained

Sr. no

Nursing Staff

1to10 bed

11to25bed

26to50bed

51 to 100 bed

Teaching hospital

Staff Nurse

1 for every 10 beds in IPD and 2 for OPD attendance up to 150 patients and 1 extra each for additional 100 patients.

Matron

–

E.5 Administrative staff: The number would vary as per requirement and may be outsourced.

Administrative staff

Sr. no

Administrative staff

1to10 bed

11to25 bed

26to50bed

51 to 100 bed

Teaching hospital

Office Superintendent/ Hospital Administrator

–

Accountant

–

Computer Operator

–

Security Staff*

–

193

F. Drugs

This segment includes the minimum essential drug which needs to be maintained in the facility.

F.1 Anesthetics drugs

Category: Anesthetics drugs

Sr. no.

Name of the Drug

Strength

Minimum Quantity

1.1 General Anesthesia (to be given only by a qualified Allopathy anesthetist)

Ether,

As per requirement

Halothane

As per requirement

Isoflurane*

As per requirement

Ketamine Hydrochloride Injection

10 mg / ml, 50 mg / ml

As per requirement

Nitrous Oxide

medical grade

As per requirement

Oxygen

medical grade

As per requirement

Injection Thiopentone Sodium

0.5 g, 1 g powder

As per requirement

1.2 Local Anesthesia

Injection Bupivacaine Hydrochloride

0.25%,0.5% 0.5% + 7.5% Glucose

As per requirement

Spray Ethyl Chloride

As per requirement

10.

Injection Lignocaine

Topical Forms 2-5%

As per requirement

11.

Hydrochloride 1-2% Spinal 5% + 7.5% Glucose

As per requirement

12.

Injection Lignocaine Hydrochloride + Adrenaline

1%, 2% +Adrenaline 1:200,000 In vial 1.3

As per requirement

1.3 Preoperative Medication and Sedation for Short Term Procedures

13.

Injection Atropine Sulphate

0.6 mg / ml

As per requirement

14.

Injection Diazepam

5 mg Injection 5 mg / ml

As per requirement

15.

any other medication as decided by the concerned anesthetist

As per requirement

F.2 Emergency drugs

Category: Emergency Drugs

Sr. no.

Name of the Drug

Strength

Minimum Quantity

Inj. Adrenaline

As per I.P.

Minimum 10 Ampoules/ Vials

Inj. Atropine

As per I.P.

Minimum 10 Ampoules/ Vials

Inj. Calcium Carbonate

As per I.P.

Minimum 10 Ampoules/ Vials

Inj. Dopamine

As per I.P.

Minimum 10 Ampoules/ Vials

Inj. Dobutamine

As per I.P.

Minimum 10 Ampoules/ Vials

Inj. Nitroglycerine

As per I.P.

Minimum 10 Ampoules/ Vials

Inj. Sodium Bicarbonate

As per I.P.

Minimum 10 Ampoules/ Vials

Inj. Hydrocortisone

As per I.P.

Minimum 10 Ampoules/ Vials

Inhaler Beclomethasone (250 micro/dose)

As per I.P.

Minimum 10 Ampoules/ Vials

10.

Inhaler Salbutamol (200 micrograms)

As per I.P.

Minimum 10 Ampoules/ Vials

11.

Inj. Frusemide

As per I.P.

Minimum 10 Ampoules/ Vials

12.

Inj. Diazepam/Midazolam

As per I.P.

Minimum 10 Ampoules/ Vials

13.

Inj. Deriphyllin

As per I.P.

Minimum 10 Ampoules/ Vials

194

14.

Inj. Phenytoin sodium

As per I.P.

Minimum 10 Ampoules/ Vials

15.

Inj. Avil

As per I.P.

Minimum 10 Ampoules/ Vials

16.

Inj. Ondansetrone

As per I.P.

Minimum 10 Ampoules/ Vials

17.

Inj. KCl

As per I.P.

Minimum 10 Ampoules/ Vials

18.

Inj. Lignocaine 2%

As per I.P.

Minimum 10 Ampoules/ Vials

19.

Inj. Amiadarone

As per I.P.

Minimum 10 Ampoules/ Vials

20.

Inj. Magnesium sulphate

As per I.P.

Minimum 10 Ampoules/ Vials

21.

Inj. Mannitol

As per I.P.

Minimum 10 Ampoules/ Vials

22.

Inj. Morphine/Inj. Pethidine

As per I.P.

Minimum 10 Ampoules/ Vials

23.

Inj. Noradrenaline bititrate

As per I.P.

Minimum 10 Ampoules/ Vials

24.

Inj. Fentanyl

As per I.P.

Minimum 10 Ampoules/ Vials

25.

water for Injection

As per I.P.

Minimum 10 Ampoules/ Vials

26.

Inj. Sodium Valporate

As per I.P.

Minimum 10 Ampoules/ Vials

27.

Inj. Voveran

As per I.P.

Minimum 10 Ampoules/ Vials

28.

Inj. Paracetamol

As per I.P.

Minimum 10 Ampoules/ Vials

29.

Mannitol Injection

As per I.P.

Minimum 10 Ampoules/ Vials

30.

Metoprolol Injection

As per I.P.

Minimum 10 Ampoules/ Vials

31.

N/2 saline Injection

As per I.P.

Minimum 10 Ampoules/ Vials

32.

Oxygen Inhalation

As per I.P.

Minimum 10 Ampoules/ Vials

33.

Oxytocin Injection

As per I.P.

Minimum 10 Ampoules/ Vials

F.3 General Drugs:

The list of essential drugs to be procured for any homoeopathic hospital shall be

in compliance of the Govt. of India Essential Drug List (EDL) – Homoeopathy – 2013

195

G. Consumables

This includes the minimum quantity of the commonly used consumables in the facility which should be made available.

G.1 Surgical

Sr. no.

Surgical Consumables

Sr. no.

Surgical Consumables

Bandage rolled

1. Plastic aprons

caps & mask

Prolene

Catgut Chromic a)1 No., 2 No., 1-0 No, 2-0 N0, 8-0

Rubber Mackintosch Sheet in meter

Clinical thermometer

Scalp vein sets no a)19, 20, 21, 22, 23, 24, 25, 26

Developer

Shaving blade –packet of 5

Draw sheets

Small and larg6e. plastic bottle for keeping his to histo-pathological samples

ECG Paper Roll

sterial sheets7.

Ether Anesthetic 500ml

Sterile disposable syringes

Fixer

9. sterile Dressing pads

10.

Gown

10.

Sterile Infusion sets(Plastic)

11.

Halothane

11.

Sterile Surgical rubber gloves

12.

HIV Kits if necessary

12. Surgical Disposable

13.

Hypodermic Needle (Pkt of 10 needle) No.19, 20, 21, 22, 23, 24, 25, 26

13.

Surgical Gloves a)6 “, 6.1/2″, 7″, 7.5″

14.

Indicator tape for sterilization by pressure autoclave

Surgical mark1i4n.g pens/permanent marker ink pen

15.

Isopropyl Alcohol swab

15. Sutupak 1,1/0,2,2/0

16.

IV Cannula

16.

Syringes 2ml,5ml,10ml, 20ml

17.

Leg drape

17. tongue depressor

18.

Mackintosh

18. Ultrasound scan film

19.

Mask

Vicryl No.1 19.

20.

Non Sterile Surgical rubber gloves

X Ray film 502fi0lm. packet(in Pkt) size, 6.1/2×8.1/2″, 8″x10″, 10″x12′, 12″x15”

G.2 Dressing Material

Sr. no

Dressing Material

Sr. no

Dressing Material

Absorbent cotton I.P 500gm Net

Bandages

Adhesive plaster 7.5cm x 5mtr

Gamjee Pad and Rolls

Adhesive tape

Rolled Bandage a)6cm,10cm,15cm

Antiseptic cream

Sterile & non sterile Gloves of different sizes

Antiseptic solution

Sterile cotton, gamjee pads, gauze pieces

Bandage cloth(100cmx20mm)

Surgical Gauze (50cmx18m)

Suture removal

196

G.3 Disinfectants: As applicable in adequate quantity

Sr. no

Disinfectants

Hypochlorite 4%-6%

Ortho-phthalaldehyde (OPA)

70% ethanol plus10ppm Bitrex

Formaldehyde solutions (1%–2%)

Glutaraldehyde

Hydrogen peroxide

Quaternary ammonium compounds

Phenolic germicides

G.4 Tubing

G.5 Linen

Sr. no

Tubing

Connecting tubing’s for endotracheal suction

Connecting tubing’s for oxygen delivery

Oxygen catheters

Oxygen masks

Suction catheters

Foley catheters

Sr. no

Linen

1to10 bed

11to25 bed

26to50 bed

51 to 100 bed

Teaching hospital

Abdominal sheets for OT

–

Abdominal sheets for OT

–

Apron for cook

–

As per requirement

Bed sheets

–

200

300

400

500

Bedspreads

–

300

400

500

Blankets

–

one per bed

Curtain cloth windows and doors

As per requirement

Doctor’s overcoat

one per doctor

Draw sheet for wards & OT

Two per bed

10.

Hospital worker OT coat

one per worker

11.

Leggings

as per patient load

12.

Mackintosh sheet (in meters)

one per bed

13.

Mats (Nylon)

one per bed

14.

Mattress (foam) adults

one per bed

15.

Pediatric Mattress

one per bed

16.

Patient house coat (for female)

Two per bed

197

17.

Patients pajama (for male) shirts

Two per bed

18.

towels

Two per bed

19.

Perineal sheets for OT

as per patient load

20.

Pillow covers

Two per bed

21.

Pillows

Two per bed

22.

Table cloth

adequate quantity

23.

Uniform / Apron

As per requirement

G.6 Stationery

Consent Forms

Continuation Sheets for IPD

Continuation sheets for OPD

Death Certificate Books

Diet Cards

Diet Sheets

Discharge cards

Gynecological and Obst. Case sheets

Indoor Admission Form & Case Sheets

Intake Output Charts

Medical Case Sheets

Medico-Legal Forms

Repertorisation chart

Nursing Monitoring Forms

OPD Forms

Pathological Books

Registers

Registration Card

Sentinel Event Form

Supplementary Sheets

Surgical Case Sheets

Temperature Charts

Treatment Cards

White Papers

X-ray Forms

G.7 Adhesives and gels: NA G.8 Other: NA

198

H. Licenses

This includes the minimum statutory compliance applicable as per the Central or State Government along with licensing body.

Name of the Act

Department/ Area

Licensing body

Registration under Shops and Establishment Act

Organization

Jurisdictional Authorities like Panchayat/ Nagarpalika/ Mahanagarpalika/ Municipality/ Municipal Corporation

Registration under Clinical Establishment Act

Organization

Jurisdictional Authorities like Panchayat/ Nagarpalika/ Mahanagarpalika/ Municipality/ Municipal Corporation

AERB clearances for CT/ MRI/ X ray & Radiation

Imaging

Atomic Energy Regulatory Board

Agreement for Common Biomedical Waste Collection, Transportation, Treatment, Storage and Disposal Facility

Organization

Local Pollution Control Board

Registration under Air (prevention and control of pollution) Act, 1981.

Organization

Local Pollution Control Board

Approval of Radiation Safety Officer

Imaging

Atomic Energy Regulatory Board

Boiler license under Indian Boiler Act, 1923

Boiler

Concerned regulatory Body

Building Permit (From the Municipality).

To be obtained from

Jurisdictional Revenue Authorities like Panchayat/ Nagarpalika/ Mahanagarpalika/ Municipality/ Municipal Corporation

Certificate for Narcotics & Psychotropic Substances

Pharmacy and / Hospital

Drug Controller

Certificate of Registration under society act 1860

Organization

Registrar of societies/ Charity Commissioners office

Certificate u/s 80-G of IT Act

Organization

If applicable.

Class clearance certificate issued to manufacturer/ importer of mobile X ray equipment

Imaging

AERB Class Clearance issued to Manufacturer/ dealer of imaging equipment

Commissioning approval of Linear Accelerator

Radiation Therapy

AERB

ESIS registration in case of >20 employees

Organization

Employee State Insurance Company

Excise permit to store Spirit.

Organization

Excise department

Generator Exhaust air Quality Report

Generator

Authorized Air Testing Laboratory

License to sale or distribute drugs Form 20, 21, 21C

Pharmacy

FDA

License for procurement & storage & dispensing of Alcohol

Pharmacy

Excise Dept.

199

License for lift

Lift

Mobile Electric Vehicles Department

License to play music for public use

Organization

Indian

No objection certificate from the Chief Fire Officer.

Organization

Fire Department

Obtaining clearances for weighing equipments in all the hospital units under The Standards of Weights and Measures Act, 1976.

Weights and measures

Department of Weights and Measures

Occupation Certificate

To be obtained from

Jurisdictional Revenue Authorities like Panchayat/ Nagarpalika/ Mahanagarpalika/ Municipality/ Municipal Corporation

PC PNDT Act, 1996.

Sonography

Health Department of Regulatory Body assigned with the responsibility

Registration of births and deaths Act, 1969.

Organization

Health Department of Regulatory Body assigned with the responsibility

SMPV License for Storage of Liquid Oxygen, Form III (License to compressed gas in pressure vessel or vessels)

Medical Gases in Pressurized Vessels

Licensing Authority

TAN Number

Organization

Income Tax Department

PAN Number

Organization

Income Tax Department

Vehicle Registration certificates for Ambulance

Ambulance and Vehicles owned by the organization

Road Traffic Authority

Water Prevention and control of pollution Act

Organization

Pollution Control Board

200

I. Basic Processes

I.1 Registration (This will help in developing a database at State / Central level)

1. Name,

2. Age,

3. Gender ,

4. Address with PIN code, 5. Marital Status,

6. Contact Number

7. Type of Diet (Veg, Non-veg),

8. OP/ IP Number,

9. Date & Time of visit for OP/ admission for IP, 10. Name of Treating Doctor

I.2 Assessment

1. Primary Complaint of the guest:

2. History of Primary Complaint:

3. History of Medication:

4. History of Implants/ Pacemaker/ Surgery:

5. Past History

6. History of allergies

7. Diet and Lifestyle History

8. Family History

9. Personal History

10. Homoeopathic Characteristics and Observations (Generalities)

11. General Examination

12. Systemic Examination

13. Physical Examination

14. Nutritional Assessment

15. Diagnosis Provisional / Final

16. Repertorisation and Repertorial Totality

17. Miasmatic assessment

18. Totality of Symptoms

19. Final Prescription (after consultation of Materia Medica)

20. Preventive Aspects

21. Plan of Care

22. Treatment

201

I.3 Infection Control

1. Cleaning: to be done with defined solution with dilution as advised by the manufacturer. Defined schedule with full cleaning at least once a day.

2. Disinfectants: Defined solution with dilution as advised by the manufacturer. Defined schedule with full cleaning at least once a day.

3. Advisable to have designated Infection Control Officer for hospital more than 50 beds.

4. Advisable to have designated Infection Control Committee for hospital more than 50 beds.

5. Infection control activities should be monitoring by defined method & schedule.

I.4 Safety considerations

(Surgical safety, infection control, biomedical waste, first aid & basic life support, disaster preparedness)

8. Following physical safety aspects shall be taken care in the hospital

1. AERB safety rules shall be followed in Radiology and other radiation areas.

2. All areas where a physical hazards may occur, like near DG set, transformer, Cylinder storage, electric panels, steep slope etc. shall be provided with safety

signage and safety instructions

3. All balconies and opening on higher floors shall have grills

4. All bottles containing acids or alkalis shall be stored on cupboards at height

below the shoulder level to prevent them from falling while taking out. It shall

never be stored on height above the head level

5. All electric panels shall be enclosed in insulated and nonflammable box and shall

be kept locked

6. All entry doors, windows and furniture shall be maintained in good maintained

condition

7. All equipments, furniture awaiting condemnation shall be stored in separate

condemnation area

8. All stretchers and wheelchairs shall have safety belts for fastening the patient

9. Anti-skid mats shall be placed on entrance of bathrooms

10. Boundary wall of the hospital’s campus shall be of sufficient height with metal

fencing on top. Entire boundary wall shall be kept in intact condition

11. Corridors and passages shall not be blocked by chairs, tables or equipments

12. Displays of ‘floor is wet’ or ‘under repair’ or similar precautions in required areas

and time shall be available with the hospital

13. Doors height shall be at least of 8 feet

14. Electric rooms shall not be used as store room or for any other purpose

15. Emergency exit routes shall be kept clear all the times

16. Hospitals ground shall be properly maintained. There shall be no openings, or

pits in the ground. The surfaces shall be kept even

17. Lab shall be provided with safety equipments like eye wash cups

18. Material safety data sheet shall be available for all hazardous materials

19. No door shall open towards public areas like crowded lobby etc. (the door shall

preferably open towards the inside of room)

202

20.No inflammable materials like, diesel, LPG, acids etc. shall be stored near electrical panel

22. Protection from stray dogs and other animals shall be ensured in the hospital campus

23. Rubber matting shall be placed on the floors below electric panels

24. Seepage shall not be allowed in areas where electric panels or wires are present

25. Terrace should have side walls of at least 4 feet height

26. The beds shall have provision for providing side guardrails.

27.There should be no losing of electrical wiring. All electrical wiring shall be

concealed and kept intact.

9. Surgical safety

1. 2.

10.

2. 3. 4.

There are two independent identifiers for each patient. Name of patient with some other independent identifier.

Identification bands for patients should be considered in cases where patient cannot be relied upon to give correct information on his own identity. E.g. pediatric, disoriented, altered consciousness, etc.

Use of surgical safety check list based on WHO Criteria is used consistently for each procedure and surgical intervention. The Checklist should divide the operation into three phases, each corresponding to a specific time period in the normal flow of a procedure

a. the period before induction of anesthesia,

b. the period after induction and before surgical incision

c. the period during or immediately after wound closure but before

removing the patient from the operating room.

In each phase the checklist task must be completed before proceeding forward.

Infection control:

Biological safety assessment is done for all areas of patient care and risks defined for the same.

a. Needle Stick Injury and related Transmissions

b. Patient to staff, patient to patient and staff to patient risk of transmission

of diseases is addressed and preventive measures are instituted.

c. Procedure site and surgical site infections are monitored.

Preventive measures and remedies for correction are kept available wherever such risk exists.

Hand washing practices as per WHO recommended criteria are followed and monitored regularly.

Facility and consumables for hand washing are available tat convenient locations in the healthcare facility.

203

1. 2. 3.

10.

2. 3.

5. 6.

Individual homoeopathic clinics as well as hospitals must have provision for handling of biomedical wastes in compliance of the Bio-Medical Waste Management Rules 2016. Bio-medical waste shall be segregated in color-coded bags (red, yellow, black, and blue), before storage, treatment, and transportation. All types of waste shall be collected, segregated, packed, transported and disposed according to the regulatory guidelines. Biological Waste Management is to be monitored on regular basis being a part of infection control activities.

First aid & basic life support

At all times there is a staff member who is adequately qualified and is trained in giving at least Basic Life Support System.

Adequate qualifications will include qualified nurse or doctor from any specialization who has undergone training on Basic Life Support.

There will be a full resuscitation set maintained for use exclusively during such events, irrespective of existence of similar equipment anywhere else in the hospital.

Disaster preparedness: Mandatory for all hospitals of all sizes.

Healthcare organization must identify various possible disasters and prepare for the same by stocking necessary consumables, training adequate staff and conducting drills regularly.

Keeping equipment in a state of readiness for use during such events.

Separate stock is maintained as per the risk perceived for the anticipated disaster(s).

Keeping a back-up of consumables at all times in usable condition for use during

disaster.

Personnel are trained for disaster management

Disaster drills are carried out at least once in six months for various disaster anticipated.

Anticipated list of disasters can include and is not restricted to any of:

a. Fire

b. Terrorist attack

c. Invasion of swarms of insects and pests.

d. Earthquake.

e. Civil disorders effecting the Organization.

f. Sudden failure of supply of electricity. (Disaster)

11.Biomedical waste:

204

I.5 Clinical Records (including consents)

Sr. no

Records

OPD/ IPD Records

Treatment Orders

Medication Records

Procedure Records

Nursing Monitoring Records

Nursing Treatment Records

Reports of investigations

Consents: General Consent at admission, Procedure consents

I.6 Discharge

Discharge Summary should have following details:

1. Primary data of Name, Gender, Age, Address with PIN code, Marital Status, Contact Number, Type of Diet (Veg, Non-veg), OP/ IP Number, Date of visit for OP/ admission for IP, Treating Doctor

2. Primary Complaint of the guest

3. History of Primary Complaint:

4. History of allergies

5. Salient Examination Findings

6. Pain Relief Advice

7. Nutritional Advice

8. Diagnosis – Final

9. Preventive Aspects

10. Treatment Given

11. Details of procedures performed

12. Treatment advised

13. Contact number in case of emergency

Fire safety majors:

Each homoeopathic hospital with indoor facility for 25 beds or more shall have fire safety majors in compliance of the National Building Code of India 2005 relating to the following matters:-

1. Access to building

2. Two Number, Width, Type and Arrangement of exits.

3. Protections of Exits by means of fire check door (s) and or pressurization.

4. Compartmentation.

5. Smoke Management System.

6. Fire Extinguishers.

7. First-Aid Hose Reels.

8. Automatic fire detection and alarming system.

9. MOEFA.

205

10. Public Address System.

11. Automatic Sprinkler System

12. Internal Hydrants and Yard Hydrants.

13. Pumping Arrangements.

14. Captive Water Storage for fire fighting

15. Exit Signage

16. Provision of Lifts (for G+3 storied buildings)

17. Standby power supply

18. Refuge Area

19. Fire Control Room

20. Special Fire Protection Systems for Protection of special Risks

Dispensary of each homoeopathic hospital shall be equipped with adequate no. of fire extinguishers to deal with the highly inflammable alcohol used for preparation of medicine. At least one fire extinguisher must be there for every 10 liters of alcohol stored either in crude or medicinal form.

RECORDS TO BE MAINTAINED BY THE CLINICAL ESTABLISHMENTS

sn Record

1 Out Patient Register

2 In Patient Register

3 Operation theater register

4 Labor room register

5 MTP Register

6 Case Records

7 Medico Legal Register

8 Laboratory Register

9 Radiology & Imaging Register

10 Discharge Summary

11 Medical Certificate in Duplicate

12 Complaint Register

13 Birth Register

14 Death Register

15 Bed Charts/Distributions/

16 RMO Duty Register

17 Total Discharges Register

18 Diet Register

19 Cash and Credit Register

20 Staff Attendance Register

21 Stock & Store Register

22 Maintenance Register

206

MINIMUM STANDARDS FOR

CLINICAL ESTABLISHMENTS OF

YOGA

207

YOGA STANDARDS FOR

CLINICS/ OPDs

1 TO 10 BEDS

11 TO 25 BEDS

26 TO 50 BEDS

51 TO 100 BEDS

100 AND ABOVE BEDS/TEACHING HOSPITALS

208

CONTENTS

Sn TITLE PAGE A Introduction 211

A.1 General 211

A.2 Scope 211

B Functions 211

B.1 Core functions (Clinical services) 211

B.2 Auxiliary Functions (support services for ex – diagnostic) 212

C Physical Facilities 213

C.1 Space requirement 213

C.1.1 Minimum area 213

C.1.2 Functional space 213

C.1.3 Dimensions of the sub areas 215

C.1.4 Basic signage 215

C.1.5 Others 216

C.2 Furniture & Fixtures 216

C.2.1 Furniture/Fixture Requirements 216

C.2.2 Sundry Articles 219

C.2.3 Others 220

C.3 Engineering Services Requirements 220

C.3.1 Electrical Requirements 220

C.3.2 Plumbing Requirements 220

C.3.3 Civil Requirements 221

C.3.4 HVAC / AC / Ventilation / Cross Ventilation Requirements 221

C.3.5 Others 221

C.4 Public Utilities 221

C.4.1 Potable drinking water 221

C.4.2 Sanitary Requirements 221

D Equipment /instruments 222

D.1 Therapeutic equipment 222

D.2 Surgical equipment N.A.

D.3 Diagnostic equipment 224

E Manpower 225

E.1 Medical practitioners 225

E.2 Therapists 225

E.3 Non-Technical staff 226

E.5 Administrative staff 227

G Consumables 227

G.5 Linen 227

G.6 Stationery 228

209

Licenses

228

Basic Processes

229

I.1

Registration

229

I.2

Assessment

229

I.3

Infection Control

230

I.4

Safety considerations

230

I.5

Clinical Treatment Records

232

I.6

Discharge

232

210

A. Introduction

A.1 General

The standards thus framed are on account of the minimum requirement of this category of healthcare provider. There are no exclusions. They are dependent on the basic functions of the unit/ hospital/ provider. All sections mentioned are mandatory and include both structure and basic processes.

A.2 Scope

Scope:

Type of Health Care Facility

Scope of Services

Clinic

Outdoor care facility managed by a single Medical Officer/ Physician or a group of Medical Officer/ Physicians/ Therapists trained in concerned system (Yoga) with or without a day care facility. No overnight stay or care is provided here.

Minimum 10 beds

Health Care facility with 10 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Medical Officer/ Physician trained in the concerned system (Yoga) having graduate or postgraduate qualifications.

11 to 25 Beds

Health Care facility with 11 to 25 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Medical Officer/ Physician trained in the concerned system (Yoga) having graduate or postgraduate qualifications.

26 to 50 Beds

Health Care facility with 26 to 50 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Medical Officer/ Physician trained in the concerned system (Yoga) having graduate or postgraduate qualifications.

51 to 100 Beds

Health Care facility with 51 to 100 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Medical Officer/ Physician trained in the concerned system (Yoga) having graduate or postgraduate qualifications.

More than 100 Beds

Health Care facility with more than 100 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Medical Officer/ Physician trained in the concerned system (Yoga) having graduate or post graduate qualifications.

Teaching Hospital

Health Care facility with minimum 100 beds for indoor care and ability to monitor and treat patients requiring an overnight stay. Care is provided by Medical Officer/ Physician trained in the concerned system (Yoga) having graduate or post graduate qualifications.

B. Functions

This section includes the basic services provided by facilities. It is subdivided into two parts

B.1 Core functions (Clinical services)

(Clinics & Outdoor Patients facilities of health care organizations of Minimum 10 beds, 11 to 25, 26 to 50, 51 to 100, More than 100 beds and Teaching Hospital)

S. No.

Services

Clinic

Minimum 10 beds

11to25 beds

26to50 beds

51 to 100 beds

More than 100 beds

Teaching Hospital

Minimum Clinical Services to be provided

Yogic Counseling

Yogic diet

Shatkarma

Nabhi/ Nadi Pareeksha

Yogic Sukshma Vyayama

Yogic Surya Namaskar

Yogasanas

Yoga Nidra

Breathing Practices

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10.

Bandha

11.

Pranayamas

12.

Mudra

13.

Mantra chanting

14.

Dharana

15.

Practices leading to Dhyana

16.

Dhyana

Indoor patient’s facilities:

The indoor department of the hospital shall have separate male and female wards and distribution of beds at the rate of 65 sq. ft. area per bed ward as under:

S. No.

Services

Minimum 10 beds

11to25 beds

26to50 beds

51 to 100 beds

More than 100 beds

Teaching Hospital

Minimum Clinical Services to be provided

Yogic Counseling

Yogic diet

Shatkarma

Nabhi/ Nadi Pareeksha

Yogic Sukshma Vyayama

Yogic Surya Namaskar

Yogasanas

Yoga Nidra

Breathing Practices

Bandha

Pranayama

Mudra

Mantra chanting

Dharana

Practices leading to Dhyana

Dhyana

B.2 Auxiliary Functions (support services for ex – diagnostic) (Central Laboratory for clinical diagnosis and investigations).

1. There shall be a laboratory in the hospital complex of more than 100 beds with proper infrastructure and manpower for carrying out routine, pathological, biochemical and hematological investigations on the patients referred from outdoor and indoor departments of the hospital.

Support Services:

1. Accounting,

2. Ambulance services

3. Billing

4. Dietary services/ Canteen

5. Essential commodities like water supply, electric supply etc.

6. Finance

7. Financial accounting and auditing

8. Housekeeping and Sanitation

9. Inventory Management

10. Laundry services

11. Medical records

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12. Office Management (Provision should be made for computerized medical records with anti- virus facilities whereas alternate records should also be maintained)

13. Personnel Department 14. Purchase

15. Reception

16. Security services

17. Stores

18. Waste management Housekeeping/ sanitation,

C. Physical Facilities

C.1 Space requirement

This entails the minimum space required for carrying out the basic functions of the facility which includes:

C.1.1 Minimum area required for establishing the facility,

Type of Health Care Organization

Requirements

Stand alone building

Part of another building

Clinic

As permitted under Development control rules, Floor Space Index,

Local regulations, etc.

1to10bed

As permitted under Development control rules, Floor Space Index,

Local regulations, etc.

Local regulations related to building structures, occupancy, etc. will be followed.

11to25

26to50

51 to 100

101 and above / Teaching Hospitals

C.1.2 Functional space planning of the facility like reception area, waiting area etc.

b. Yoga hall:

1. Space should be available for minimum 30 people to practice Yoga (minimum space

requirement per person would be approximately 20 sq. ft.)

2. The hall should be approximately 600 sq.ft area. As per the bed capacity the no. of Yoga

Halls shall be increased.

3. Separate Yoga Halls are proposed for male & female with attached dressing room, toilet and

bathroom.

4. Shatkarma sthal with clean water facility (hot and cold)

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5. Dhyan kaksh

c. Yoga Therapy Treatment rooms: Minimum 50 sq.ft area per Treatment room

d. Consultation & Examination room

1. Minimum 10ft. x 8 ft.

2. Consultation room should be adequate to accommodate:

ii. Table for Consultancy

iii. Consultation chair,

iv. Two stools/ chairs,

v. X-Ray viewing screen,

vi. Examination bed of the size 6 ft X 2.0 ft.,

vii. Privacy screen around examination area while having free mobility,

viii. Wash Basin for hand wash

e. Entrance hall with reception area, enquiry counter, cash counter and record area: Preferably 100 sq. ft per 25 beds

f. Waiting area in entire organization: Preferably 100 sq. ft per 25 beds i.e. 10% seats of average number of patients visiting daily to hospital

g. Kitchen/ Canteen area:

1. Providing food is mandatory for hospitals of having indoor facility.

2. Kitchen area should be sufficient size to prepare food for inpatients as per diet advised by

the physician.

3. Kitchen layout and functioning should follow the flow of materials as: Entry> washed>

cutting> cooking> loadingTo Serve.

4. Utensil washing area is separate from the cooking area.

h. Yoga Therapist Quarters:

Minimum 1 room with attached bathroom & WC, per 2 therapist with separate rooms for male & females with separated sleeping facility with ceiling fan, drinking water facility, intercom, mattress, pillows, blankets, bed sheets. Cupboards/ wardrobes.

i. Clinical laboratory specifications:

1. Laboratory services can be outsourced or can be optional for hospitals upto 100 beds.

2. Laboratory services are mandatory for hospitals above 100 beds for quick diagnosis of blood,

urine, etc., a small sample collection room facility shall be provided.

3. Separate Reporting Room for doctors should be there.

j. Laundry (optional)

1. Laundry services can be outsourced or can be optional.

2. If it is provided in house, it should have necessary facilities for drying, pressing and storage

of soiled and cleaned linens.

3. If outsourced, disinfection of linen is carried out by the hospital before handing over the

linen to the out-sourced organization.

k. House-Keeping:

1. Housekeeping services should be made available for effective cleanliness.

2. Housekeeping services can be outsourced.

3. Designated areas within functional areas for housekeeping materials has to be in hospital

more than 30 beds

l. Security Services:

There is a designated location for each security staff on duty.

m. Medical record-room:

1. Medical record-room should be of adequate size as per the load of the documents of the

hospital (Minimum of 50 sq feet).

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2. Tamperproof material and locking facility Cabinets/ cupboards/ Boxes will be used.

3. Fire extinguishers of correct type should be made available nearby all locations.

n. Store rooms:

1. Store room should be lockable & of adequate size with exhaust fan.

2. Area should be clean, well ventilated, well lit, without any dampness or fungal growth on

walls.

14. Wards:

i. Treatment areas for male and female patients shall be segregated if managed as wards and there should be privacy for individual patients. Alternatively individual or sharing rooms can be used to segregate patients of different gender.

j. The ward planning will address minimization of the work for the nursing staff and shall provide basic amenities to the patients located within an area or unit.

k. Ward unit will include nursing station, preferably a treatment/ procedure room, nursing store and toilets as per the norms.

l. At the minimum one nursing station per ward of upto 45 beds will be provided.

m. There should be minimum 50 ft. area per bed with 7 ft. distance between the mid-points of adjoining beds and at least 3 feet distance between the beds and 8 inch distance between the

bed and the wall.

n. Width of the door to be at least 4 feet.

o. Permanent, semi-permanent or temporary partition should be present between two beds.

p. Ward store area with lockable wall or steel cupboard(s).

15. Duty rooms for Yoga Therapist

a. To accommodate 1 bed of 6 feet X 3 feet and a side table.

b. Separate beds if sharing for same gender.

c. Separate rooms for separate genders will be provided.

16. Duty rooms for nurses:

a. To accommodate 1 bed of 6 feet X 3 feet and a side table.

b. Separate beds if sharing for same gender.

c. Separate rooms for separate genders will be provided.

17. Dirty utility room:

Separate area of minimum 15 sq feet.

C.1.3 Dimensions of the sub areas of the facility, including the flow of the processes which in turn will give a layout of the department /unit.

C.1.4 Basic signage

1. A signage within or outside the facility should be made available containing the following information.

2. All signage meant for patients and visitors shall be bilingual – Local language and Hindi/ English.

C.1.4.1 Name of the care provider with registration number,

1. Name of organization.

2. Display of Registration under Clinical Establishment Act

C.1.4.2 Fee structure

1. Display of tariff list at OPD/ IPD (wherever applicable) etc.

2. Display of citizen charter in OPD/ IPD (wherever applicable)

C.1.4.3 Timings of the facility

1. Display of OPD timings with names and respective specializations of consultants in OPD C.1.4.4 Services provided

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1. Directional signage at main entrance towards OPD/IPD

2. Directional signage for patients for utilities and conveniences like toilets, drinking water,

telephone booths etc.

3. Directional signage within the hospital building for all departments within the building

4. Display of department / area name on the entrance of each area / room / counter

5. Display of hospital layout at various entrances in the hospital

6. Display of hospital’s scope of services at OPD and at Campus entrance

7. Floor Plan With Location Of Departments

8. Plan of Facility

9. Usages: departments, OPD & IP room & wards, waiting areas,

C.1.5 Others

1. Display of all radiation hazard signage in radiation areas (if applicable).

2. Display of Biomedical waste segregation at all location where BMW bins are kept

3. Display of danger signage at all electric panels and other dangerous areas

4. Display of General instructions like ‘No Smoking’, ‘Keep Silence’, ‘Use dustbin’, etc. at various

patient and visitor areas in the hospital

5. Display of hand–washing techniques compliant with WHO guidelines at all hand wash basins

6. Display of how to use fire extinguisher at all point where fire extinguisher is installed

7. Display of important phone contact numbers of hospital authorities

8. Displays required by regulations like PNDT, Lifts, Fire, etc.

9. Display of Material Safety Data Sheet at all locations where Hazardous Materials are stored

10. Display of patient rights and responsibilities in OPD and wards

11. Display of safety instructions in areas where any kind of safety hazard may be expected. This

includes areas like transformers, Cylinder storage, LPG storage etc.

12. Emergency exit signage (preferably in auto illumination material, like radium)

13. Fire Protection

14. Hazards- electrical, fall, pipe locations, prohibited areas

15. Notice board for general information to staff

16. Notice board in front of all OPD and Wards.

17. Routes for all areas

18. Signage for parking. (Signage for ambulance parking shall be separately mentioned)

19. Safety signage will be displays as per the requirements of respective Indian Standards: Ex. Fire

Protection Safety Signs IS 12349:1988

C.2 Furniture & Fixtures:

This will entail the details about the furniture and sundry items commensurate to the service delivery requirements.

C.2.1 Furniture/Fixture Requirements: 1: Furniture/Fixture Requirements for Outpatient Department (OPD)::

216

clinic

hospital

Sr. No.

Name of the Equipment

Clinic

1 to 10 Beds

11 to 25 Beds

26to50 Beds

51-100 beds

101 beds and above/ Teaching hospitals

A chair and a table for doctor 1.

1 set per consultation room

X-ray viewer

Optional

1 per consultation room

Two chairs for patients & attendants

1 set per consultation room

An examination table of 6 ft. X 2.5 ft. With privacy screen

1 per consultation room

Blood pressure apparatus,

1 per consultation room

Stethoscope

1 per consultation room

Torch,

1 per consultation room

Thermometer

1 per consultation room

Weighing machine.

1 per consultation room

10.

Essential diagnostic tools required for examination of patients as per the scope of services offered by the hospital.

As per requirement

11.

Light source which gives light colour and temperature similar to solar light,

Light intensity of at least 500 lux at the point of examination.

As per requirement

12.

Refrigerator if temperature sensitive medication are stored (if required)

1 per consultation room

13.

Computers, (if required)

1 per consultation room

14.

Telephone equipment

As per requirement

15.

Air conditioning

As per requirement

16.

Lockable storage space

As per requirement

17.

Foot stools

1 per consultation room

Rooms should be well ventilated.

2: Furniture/Fixture Requirements for In-Patient Department (IPD):

Sr. No .

Name of the Equipment

Minimum 10 bedded hospital

11-25 bedded hospital

26to50 bedded hospital

51 to 100 bedded hospital

More than 100 bedded hospital

Teaching hospital

Adequate wall or

steel Cupboards

Arm Board Adult

Back rest

Bain Marie trolley stainless steel 1 per

1 per floor

217

floor

Bed side cabinets

1 per 5 patients

1 per ward or full length curtains between the beds

As per requirement

1 per ward As needed

As needed

As per need

ABC 1 per ward/ floor based on layout As per need

1 Per Area/ Ward

1 per ward

2 per ward

Adequate

20% of total beds

1 per bed

– 1 per ward/ floor a per the profile of patients & layout of facility

1 per bed Adequate

Bed side Screen

Bucket Plastic

Ceiling Fans

Clock 1 per ward

Containers for kitchen

10.

11.

Consultant’s chair for OP & ward,

Consultant’s or Office table

12.

Dressing trolley-1 per floor/ ward depending on layout

13.

Dust bins in each ward & consultation room

14.

Duty table for Yoga therapists

15.

Fire extinguisher

16.

Foot stools

17.

Fridge

18.

Heavy duty Torchlight

19.

10+2

30+5

50+5

100+10

150+15

Hospital Cots

20.

200+20

Hot Water geyser

21.

Intercom System

22.

Kitchen utensils,

23.

Office chairs

24.

25.

Office Table

patient Beds with side rails

26.

Patient call Bell System

27.

28.

Patient locker

Patients examination table– 1 per ward/ floor a per the profile of patients & layout of facility

29.

Patients side table

30.

Steel or Wooden cup board

31.

218

32.

Steel rack

Adequate

33.

Stool 1Per Bed

As needed

34.

Stools revolving – 1 per ward

2 per ward

35.

Stretcher/ Patient trolley – 1 per ward

1 per ward

36.

waiting chairs / benches for patients relatives

50% of bed strengths

37.

Weighing Machine

1 per ward

38.

Wheel chair

2 per 50 beds

39.

X-ray viewer

one per ward

C.2.2 Sundry Articles Requirement

Furniture/Fixture Requirements

Hospital Fittings & Necessities

Sr. No

Name of the Equipment

Clinic

Minimum 10 bedded Hospital

11- 25 bedded Hospital

26-50 bedded Hospital

51-100 bedded Hospital

More than 100 bedded hospital

Teaching Hospital

Air conditioners Central A/C

Optional

Minimum 1

Ambulance

Optional

Minimum 1

Ceiling / wall Fans

As needed

Clock

1 per ward

Computer with modem with UPS, printer with internet connection

As needed

Coolers

As per need

Drinking Water purifier

As needed

Emergency lamp

2 Per Area/ Ward

Exhaust Fan

As needed

10.

Fire extinguishers

As needed

11.

Geyser

1 per ward

12.

Refrigerator

1 per ward

13.

Storage Geyser

1 per ward

14.

Tables & Chairs

As needed

15.

Telephone/ cell phone

1 per ward

16.

Tube lights

As needed

219

17.

Vacuum cleaner

As needed

C.2.3 Others

Furniture/Fixture Requirements

Administration

Sr. No.

Name of the Equipment

Clinic

Minimum 10 bedded Hospital

11- 25 bedded Hospital

26to50 bedded Hospital

51-100 bedded Hospital

More than 100 bedded hospital

Teaching Hospital

Computer with 1.

Modem with UPS, Printer with Internet Connection

As needed

Xerox Machine

As needed

1 per ward

Intercom (10 lines)

As needed

Fax Machine

–

As needed

Telephone

One per organization

Public Address System

–

Covering Indoor and OPD Areas

C. 3 Engineering Services Requirements

This will include the detail information about the basic requirements including

C.3.1 Electrical Requirements

7. At least 3 hours backup or generator for critical areas

8. Primary electrical Supply is available as provided by the local utility provider. Lighting back up

for at least 1 hour covering all functional areas must be available during the functioning time.

9. Primary electrical Supply as supplied by utility provider. Emergency backup for at least 3 hours backup for electricity & for lighting and critical equipment must be available during the functioning time. Take over time must be less than 30 seconds. Electr

deemagclinic

Clinical establishment act