Guidelines For Distt Hospitals - Indian Public Health Standards

Indian Public Health Standards (IPHS)
Guidelines for
District Hospitals
(101 to 500 Bedded)
Revised 2012
Directorate General of Health Services
Ministry of Health & Family Welfare
Government of India
Indian Public Health Standards (IPHS)
Guidelines for
District Hospitals
(101 to 500 Bedded)
Revised 2012
Government of India
!"#$%#$&
'())*+( -
./0(1/02 -3
40(5*6( -33
7689/1:(2+(;(9<) -333
Execuve Summary =
>?32(:39() 5/0 @3)<036< A/)B3<*:) C
Introducon C
Objecves of Indian Public Health Standards (IPHS) for District Hospitals D
Denion E
>0*239+ /5 @3)<036< A/)B3<*:) E
Funcons E
&(0-36() E
Physical Infrastructure 2D
'*9B/1(0 F(G?30(;(9<) CH
%G?3B;(9< #/0;) CI
Laboratory Services at District Hospital EI
Recommended Allocaon of Bed Strength H=
Requirements of Operaon Theatre H=
List of Drugs/Lab Reagents/Other Consumables and Disposables for District Hospitals H2
Capacity Building JK
Quality Assurance and Quality Control of Processes and Service Delivery JK
Statuary Compliance J=
Rogi Kalyan Samies (RKS)/Hospital Management Commiee (HMC) J=
Cizens Charter J2
799(L?0()
799(L?0( M Cizens Charter JC
799(L?0( MM A/)B3<*: N*)<( '*9*+(;(9< JH
799(L?0( MM 7 Naonal Guidelines on Hospital Waste Management
based upon the Bio-medical Waste (Management & Handling) Rules, =OOI JH
Annexure II B Guidelines to Reduce Environmental Polluon due to Mercury Waste I=
799(L?0( MMM Guidelines for Air Borne Infecon Control 82
799(L?0( MP Steps for Safety in Surgical Paents 84
799(L?0( P Referral Laboratory Networks IH
799(L?0( PM Special Newborn Care Unit (SNCU) at @3)<036< A/)B3<*: IO
799(L?0( PMM Management Informaon System (MIS) Format OE
799(L?0( PMMM List of Statutory Compliances 102
799(L?0( MQ Seismic Safety Guidelines 103
799(L?0( Q Facility based Maternal Death Review Form =KE
799(L?0( QM List of Abbreviaons =KI
F(5(0(96() =KO
'(;R(0) /5 $*)8 ./06( 5/0 F(-3)3/9 /5 M4A& ==K
'%&&7>%
Naonal Rural Health Mission (NRHM) was launched to strengthen the Rural Public Health
System and has since met many hopes and expectaons. The Mission seeks to provide eecve
health care to the rural populace throughout the country with special focus on the States and
Union Territories (UTs), which have weak public health indicators and/or weak infrastructure.
Towards this end, the Indian Public Health Standards (IPHS) for Sub-Centres, Primary Health
Centres (PHCs), Community Health Centres (CHCs), Sub-District and District Hospitals were
published in January/February, 2007 and have been used as the reference point for public health
care infrastructure planning and up-gradaon in the States and UTs. IPHS are a set of uniform standards envisaged
to improve the quality of health care delivery in the country.
The IPHS documents have been revised keeping in view the changing protocols of the exisng programmes and
introducon of new programmes especially for Non-Communicable Diseases. Flexibility is allowed to suit the
diverse needs of the states and regions.
Our country has a large number of public health instuons in rural areas from sub-centres at the most peripheral
level to the district hospitals at the district level. It is highly desirable that they should be fully funconal and deliver
quality care. I strongly believe that these IPHS guidelines will act as the main driver for connuous improvement in
quality and serve as the bench mark for assessing the funconal status of health facilies.
I call upon all States and UTs to adopt these IPHS guidelines for strengthening the Public Health Care Instuons
and put in their best eorts to achieve high quality of health care for our people across the country.
New Delhi (Ghu|am Nab| Azad)
23.11.2011
."F%N"F@
As envisaged under Naonal Rural Health Mission (NRHM), the public health instuons in
0?0*: *0(*) *0( </ R( ?B+0*2(2 50/; 3<) B0()(9< :(-(: </ * :(-(: /5 * )(< /5 )<*92*02) 6*::(2
Indian Public Health Standards (IPHS). The Indian Public Health Standards are the benchmarks
for quality expected from various components of public health care organizaons and may be
used for assessing performance of health care delivery system.
District Hospital is a hospital at the secondary referral level responsible for a district of a dened
geographical area containing a dened populaon. Its objecve is to provide comprehensive
secondary health care services to the people in the district at an acceptable level of quality and
being responsive and sensive to the needs of people and referring centres. Every district is expected to have a
district hospital.
As seng standards is a dynamic process, need was felt to update the IPHS keeping in view the changing
protocols of exisng Naonal Health Programmes, introducon of new programmes & iniaves especially
Non-Communicable Diseases and the prevailing epidemiological situaon in the country. Three documents
for District Hospitals (101-200 bedded, 201-300 bedded and 301-500 bedded) have been merged, indicang
standards for 100, 200, 300, 400 and 500 bedded hospitals in one document. The revision has been carried
out by a task force comprising of various stakeholders under the Chairmanship of Director General of Health
Services. Subject experts, NGOs, State representaves, health workers working in the health facilies have also
been consulted at dierent stages of revision.
This document will help the State Governments and Panchaya Raj Instuons, to monitor eecvely as to how
many of the District Hospitals are conforming to IPHS and strive to upgrade the remaining to the desired level.
I would like to acknowledge the eorts of the Directorate General of Health Services in preparing the guidelines.
It is hoped that this document will be useful to all the stakeholders. Comments and suggesons for further
improvements are most welcome.
(.k.radhan)
4F%.7!%
Standards are a means of describing a level of quality that the health care organizaons are
expected to meet or aspire to achieve. For the rst me under Naonal Rural Health Mission
(NRHM), an eort had been made to develop Indian Public Health Standards (IPHS) for a vast
network of peripheral public health instuons in the country and the rst set of standards was
released in early 2007 to provide opmal specialized care to the community and achieve and
maintain an acceptable standard of quality of care.
The IPHS for District Hospitals has been revised keeping in view the resources available with
respect to funconal requirements with minimum acceptable standards for such as building,
manpower, instruments and equipment, drugs and other facilies etc. The task of revision was completed as a
result of consultaons held over many months with task force members, programme ocers, Regional Directors
of Health and Family Welfare, experts, health funconaries, representaves of Non-Government organizaons,
development partners and State/Union Territory Government representaves aer reaching a consensus. The
contribuon of all of them is well appreciated.
In this revised IPHS document, services that a District Hospital is expected to provide have been grouped as
Essenal (Minimum Assured Services) and Desirable (which we should aspire to achieve). Besides the basic
specialty services, due importance has been given to Newborn Care, Psychiatric services, Physical Medicine and
Rehabilitaon services, Accident and Trauma Services, Dialysis services, An-retroviral therapy and Paent Safety
and Infecon control norms. District Hospital should be in a posion not only to provide all basic specialty services
but should aim to develop super-specialty services gradually. District Hospital also needs to be ready for epidemic
and disaster management all the mes. In addion, it should provide facilies for skill based trainings for dierent
levels of health care workers.
I hope that this document will be of immense help to the States/Union Territories and other stakeholders in
bringing up the health facilies to the level of Indian Public Health Standards.
(Dr. Iagd|sh rasad)

The revision of the exisng guidelines for Indian Public Health Standards (IPHS) for dierent levels of Health
Facilies from Sub-Centre to District Hospitals was started with the formaon of a Task Force under the
Chairmanship of Director General of Health Services (DGHS). This revised document is a concerted eort made
possible by the advice, assistance and cooperaon of many individuals, Instuons, government and non-
government organizaons.
I gratefully acknowledge the valuable contribuon of all the members of the Task Force constuted to revise
Indian Public Health Standards (IPHS). The list of Task Force Members is given at the end of this document. I am
thankful to them individually and collecvely.
I am truly grateful to Mr. P.K. Pradhan, Secretary (H & FW) for the acve encouragement received from him.
I also gratefully acknowledge the iniave, inspiraon and valuable guidance provided by Dr. Jagdish Prasad,
Director General of Health Services, Ministry of Health and Family Welfare, Government of India. He has also
extensively reviewed the document while it was being developed.
I sincerely thank Miss K. Sujatha Rao, Ex-Secretary (H&FW) for her valuable contribuon and guidance
in raonalizing the manpower requirements for Health Facilies. I would specially like to thank
Ms. Anuradha Gupta, Addional Secretary and Mission Director NRHM, Mr. Manoj Jhalani Joint Secretary
(RCH), Mr. Amit Mohan Prasad, Joint Secretary (NRHM), Dr. R.S. Shukla Joint Secratary (PH), Dr. Shiv
Lal, former Special DG and Advisor (Public Health), Dr. Ashok Kumar, DDG Dr. N.S. Dharm Shaktu, DDG,
Dr. C.M. Agrawal DDG, Dr. P.L. Joshi former DDG, experts from NHSRC namely Dr. T. Sunderraman,
Dr. J.N. Sahai, Dr. P. Padmanabhan, Dr. J.N. Srivastava, experts from NCDC Dr. R.L. Ichhpujani, Dr. A.C. Dhariwal,
Dr. Shashi Khare, Dr. S.D. Khaparde, Dr. Sunil Gupta, Dr. R.S. Gupta, experts from NIHFW Prof. B. Deoki Nandan,
Prof. K. Kalaivani, Prof. M. Bhaacharya, Prof. J.K. Dass, Dr. Vivekadish, programme ocers from Ministry of
Health Family welfare and Directorate General of Health Services especially Dr. Himanshu Bhushan, Dr. Manisha
Malhotra, Dr. B. Kishore, Dr. Jagdish Kaur, Dr. D.M. Thorat and Dr. Sajjan Singh Yadav for their valuable contribuon
and guidance in formulang the IPHS documents.
I am grateful to the following State level administrators, health funconaries working in the health facilies and
NGO representaves who shared their eld experience and greatly contributed in the revision work; namely:
Dr. Manohar Agnani, MD NRHM from Government of MP Dr. Junaid Rehman from Government of Kerala.
Dr. Kamlesh Kumar Jain from Government of Chhasgarh.
7!S#"NT%@>%'%#$&
Indian Public Health Standards (IPHS): Guidelines for @M&$FM!$ A"&4M$7T&
ix
Dr. Y.K. Gupta, Dr. Kiran Malik, Dr. Avdesh Kumar, Dr. Naresh Kumar, Smt. Prabha Devi Panwar, ANM and
Ms. Pushpa Devi, ANM from Government of Uar Pradesh.
Dr. P.N.S. Chauhan, Dr. Jayashree Chandra, Dr. S.A.S. Kazmi, Dr. L.B. Asthana, Dr. R.P. Maheshwari,
Dr. (Mrs.) Pushpa Gupta, Dr. Ramesh Makwana and Dr. (Mrs.) Bhusan Shrivastava from Government of
Madhya Pradesh.
Dr. R.S. Gupta, Dr. S.K. Gupta, Ms. Mamta Devi, ANM and Ms. Sangeeta Sharma, ANM from Government of
Rajasthan.
Dr. Rajesh Bali from Government of Haryana.
NGO representaves: Dr. P.K. Jain from RK Mission and Dr. Sunita Abraham from Chrisan Medical Associaon
of India.
Tmt. C. Chandra, Village Health Nurse, and Tmt. K. Geetha, Village Health Nurse from Government of
Tamil Nadu.
I express my sincere thanks to Architects of Central Design Bureau namely Sh. S. Majumdar, Dr. Chandrashekhar,
Sh. Sridhar and Sh. M. Bajpai for providing inputs in respect of physical infrastructure and building norms.
I am also extremely grateful to Regional Directors of Health and Family Welfare, State Health Secretaries, State
Mission directors and State Directors of Health Services for their feedback.
I shall be failing in my duty if I do not thank Dr. P.K. Prabhakar, Deputy Commissioner, Ministry of Health and
Family Welfare for providing suggesons and support at every stage of revision of this document.
Last but not the least the assistance provided by my secretarial sta and the team at Macro Graphics Pvt. Ltd.
is duly acknowledged.
(Dr. Anil Kumar)
Member Secretary-Task force
CMO (NFSG)
June 2012 Ministry of Health & Family Welfare
New Delhi Government of India
District Hospital is a hospital at the secondary
0(5(00*: :(-(: 0()B/9)3R:( 5/0 * 23)<036< /5 * 2(539(2
geographical area containing a defined population.
Its objective is to provide comprehensive secondary
health care services to the people in the district at
an acceptable level of quality and being responsive
and sensitive to the needs of people and referring
centres. Every district is expected to have a district
hospital. As the population of a district is variable,
the bed strength also varies from 75 to 500 beds
depending on the size, terrain and population of the
district.
Service Delivery
District Hospital should be in a posion to provide
all basic speciality services and should aim to
develop super-specialty services gradually. District
Hospital also needs to be ready for epidemic and
disaster management all the mes. In addion, it
should provide facilies for skill based trainings
for dierent levels of health care workers. In this
IPHS document, Services that a District Hospital is
expected to provide have been grouped as Essenal
(Minimum Assured Services) and Desirable (which
we should aspire to achieve). The services include
OPD, indoor and Emergency Service. Besides the basic
specialty Services, due importance has been given to
Newborn Care, Psychiatric services, Physical Medicine
and Rehabilitaon services, Accident and Trauma
Services, Dialysis services and An-retroviral therapy.
It is desirable that Super-speciales and related
diagnosc facilies be made available, in more than
300 bedded hospitals. Every district hospital should
provide facilies of Special Newborn Care Units (SNCU)
with specially trained sta. Provisions for Paent Safety,
infecon control and Health Care workers Safety have
been added. It is desirable that every District Hospital
should have a Post Partum Unit with dedicated sta
to provide Post natal services, all Family Planning
Services, Safe Aboron services and immunizaon in
an integrated manner.
Requirement for Delivery of the
Above-menoned Services
The requirements have been projected on the basis
of esmated case load for hospital of this strength.
The guidelines of hospital building, planning and
layout, signage, disaster prevenon measures for
new facilies, barrier free access and environmental
friendly features have been included. Provisions for
quality assurance in clinics, laboratories, blood bank,
ward unit, pharmacies, and accident & emergency
services have been made. Manpower has been
raonalized and addional manpower has been
provided for Physical medicine and Rehabilitaon
Services, Dental, Radiotherapy, Immunizaon and
young hearing impaired. Naonal Guidelines on
hospital waste management, Guidelines to reduce
environmental polluon due to mercury waste,
Surgical Safety Checklist for safety of Surgical Paents
in ward and Operaon Theatre, Management
Informaon System format for monthly reporng, list
EXECUTIVE SUMMARY
2
of statutory compliance and Seismic safety guidelines
have been included.
A Charter of Paents Rights for appropriate
informaon to the beneciaries, grievance redressal
and constuon of Hospital Management Commiee
for beer management and improvement of
hospital services with involvement of Panchaya Raj
Instuons (PRI) and NGOs have also been made
as a part of the Indian Public Health Standards. The
monitoring process and quality assurance mechanism
are also included.
Standards are the main driver for connuous
improvements in quality. The performance of District
Hospital can be assessed against the set standards. This
would help monitor and improve the funconing of the
District Hospitals in the country.
Introducon
Indias Public Health System has been developed
over the years as a 3-tier system, namely primary,
secondary and tertiary level of health care.
District Health System is the fundamental basis
for implementing various health policies, delivery
of healthcare and management of health services
for defined geographic area. District hospital is an
essential component of the district health system
and functions as a secondary level of health care
which provides curative, preventive and promotive
healthcare services to the people in the district.
Every district is expected to have a district hospital
linked with the public hospitals/health centres down
below the district such as Sub-district/Sub-divisional
hospitals, Community Health Centres, Primary
Health Centres and Sub-centres. However, at present
there are 605 district hospitals in 640 districts of the
country as per NRHM data as on 30-6-2010.
The Government of India is strongly commied to
strengthen the health sector for improving the health
status of the populaon. A number of steps have been
taken to that eect in the post independence era.
One such step is strengthening of referral services
and provision of speciality services at district and
sub-district hospitals. Various specialists like surgeon,
physician, obstetrician and gynaecologist, paediatrician,
orthopaedic surgeon, ophthalmologist, anaesthest,
ENT specialist and denst have been placed in the
district headquarter hospital.
The district hospitals cater to the people living in urban
(district headquarters town and adjoining areas) and
the rural people in the district. District hospital system
is required to work not only as a curave centre but
at the same me should be able to build interface
with the instuons external to it including those
controlled by non-government and private voluntary
health organizaons. In the fast changing scenario, the
objecves of a district hospital need to unify scienc
thought with praccal operaons which aim to integrate
management techniques, interpersonal behaviour
and decision making models to serve the system and
improve its eciency and eecveness. By establishing
a telemedicine link with district to referral hospital
(Medical College) with video-conferencing facility
(desirable), the quality of secondary and limited terary
care can be improved considerably at district hospitals.
The current funconing of the most of the district
hospitals in the public sector are not up to the
expectaon especially in relaon to availability,
accessibility and quality. The sta strength, beds
strength, equipment supply, service availability and
populaon coverage are not uniform among all the
district hospitals.
As per Census 2001, the populaon of a district varies
from as low as 32,000 (Yanam in Pondicherry, Lahaul
& Spi in Himachal Pradesh) to as high as 30 lakhs
(Ludhiana, Amritsar districts). The bed strength also
varies from 75 to 500 beds depending on the size,
terrain and populaon of the district. The second phase
>UM@%TM#%& ."F @M&$FM!$ A"&4M$7T&
4
of the facility survey undertaken by the Ministry of
Health & Family Welfare, Government of India, covering
370 district hospitals from 26 states has revealed that
59% of the surveyed district hospitals have tap water
facility; the electricity facility is available in 97% of
the districts with a stand by generator facility in 92%
of the cases. Almost all the District Hospitals in India
have one operaon theatre and 48% of them have an
OT specically for gynaecological purpose. About 73%
of the surveyed district hospitals have laboratories. A
separate asepc labour room is found in only 45% of
the surveyed district hospitals. Only half of the total
numbers of district hospitals have OPD facility for RTI/
STI. As regards manpower 10% of the district hospitals
do not have O&G specialists and paediatricians. 80% of
the District Hospitals have at least one pathologist and
83% at least one anaesthest. General duty Medical
ocers, sta nurses, female health workers and
laboratory technicians are available in almost all district
hospitals. Only 68% of the district hospitals have linkage
with the district blood banks.
Most of the district hospitals suer from large number
of constraints such as:
Buildings are either very old and in dilapidated
condions or are not maintained properly,
because of lack of convergence with
maintenance department.
The facilies at district hospitals require
connued upgradaon to keep pace with the
advances in medical knowledge, diagnosc
procedures, storage and retrieval of informaon.
It has been observed that development of
hospitals is not keeping pace with the scienc
development.
A typical district hospital lacks modern
diagnoscs and therapeuc equipment, proper
emergency services, intensive care units,
essenal pharmaceucals and supplies, referral
support and resources.
There is a lack of trained and qualied
sta for hospital management and for the
management of other ancillary and supporve
services viz. medical records, central sterilizaon
department, laundry, house keeping, dietary
and management of nursing services.
There is lack of community parcipaon and
ownership, management and accountability of
district hospitals through hospital management
commiees.
District Hospitals have come under constantly

increasing pressure due to increased ulizaon as
a result of rapid growth in populaon, increase in
awareness among common consumers, biomedical
advancement resulng in the use of sophiscated
and advanced technology in diagnosis and therapies,
and constantly rising expectaon level of the use of
the services. The need for evaluang the care being
rendered through district hospitals has gained strength
of late. There is a need to provide guidance to those
concerned with quality assurance in district hospitals
services to ensure eciency and eecveness of the
services rendered.
The Bureau of Indian standards (BIS) has developed
standards for hospitals services for 30 bedded and 100
bedded hospitals with primary emphasis on structural
component. However, these standards are considered
very resource intensive and lack the processes to ensure
community involvement, accountability, the hospital
management and cizens charter etc. peculiar to the
public hospitals. Of late NABH standards are in vogue,
however they are mainly process based standards and
lack the structural components. In this context a set of
standards are being recommended for district hospitals
6*::(2 *) Ind|an ub||c nea|th Standards (InS) for
D|str|ct nosp|ta|s. This document contains the standards
to bring the District Hospitals to a minimum acceptable
funconal grade (indicated as Lssenna|) with scope for
further improvement (indicated as Des|rab|e) in it.
Objecves of Indian Public Health
Standards (IPHS) for District
A/)B3<*:)
The overall objecve of IPHS is to provide health care
that is quality oriented and sensive to the needs of the
people of the district. The specic objecves of IPHS for
District Hospitals are:
To provide comprehensive secondary health
care (specialist and referral services) to the
community through the District Hospital.
To achieve and maintain an acceptable
standard of quality of care.
To make the services more responsive and
sensive to the needs of the people of the
district and the hospitals/centres from where
the cases are referred to the district hospitals.
1.
2.
3.
5
Denion
The term District Hospital is used here to mean a
hospital at the secondary referral level responsible for
a district of a dened geographical area containing a
dened populaon.
>0*239+ /5 @3)<036< A/)B3<*:)
The size of a district hospital is a funcon of the hospital
bed requirement, which in turn is a funcon of the size
of the populaon it serves. In India the populaon
size of a district varies from 35,000 to 30,00,000
(Census 2001). Based on the assumpons of the annual
rate of admission as 1 per 50 populaons and average
length of stay in a hospital as 5 days, the number of beds
required for a district having a populaon of 10 lakhs
will be around 300 beds. However, as the populaon of
the district varies a lot, it would be prudent to prescribe
norms by grading the size of the hospitals as per the
number of beds.
Grade I: District hospitals norms for 500 beds
Grade II: District Hospital Norms for 400 beds
Grade III: District hospitals norms for 300 beds
Grade IV: District hospitals norms for 200 beds
Grade V: District hospitals norms for 100 beds.
The disease prevalence in a district varies widely in type
and complexies. It is not possible to treat all of them
at district hospitals. Some may require the intervenon
of highly specialist services and use of sophiscated
expensive medical equipment. Paents with such
diseases can be transferred to terary and other
specialized hospitals. A district hospital should however
be able to serve 85-95% of the medical needs in the
districts. It is expected that the hospital bed occupancy
rate should be at least 80%.
Funcons
A district hospital has the following funcons:
It provides eecve, aordable health care
services (curave including specialist services,
prevenve and promove) for a dened
populaon, with their full parcipaon and in
co-operaon with agencies in the district that
have similar concern. It covers both urban
populaon (district head quarter town) and the
rural populaon in the district.
Funcon as a secondary level referral centre
for the public health instuons below the
district level such as Sub-divisional Hospitals,
Community Health Centres, Primary Health
Centres and Sub-centres.
To provide wide ranging technical and
administrave support and educaon and
<0*3939+ 5/r primary health care.
1.
2.
3.
Lssenna| Des|rab|e
Genera| Spec|a|nes
>(9(0*: '(23639(
General Surgery
Obstetric & Gynaecology Services
Family Planing services like Counseling, Tubectomy (Both
Laparoscopic and Minilap), NSV, IUCD, OCPs, Condoms,
ECPs, Follow up services
Paediatrics including Neonatology and Immunizaon
Emergency (Accident & other emergency)
Crical care/Intensive Care (ICU)
Anaesthesia
Ophthalmology
Genera| Spec|a|nes
Dermatology and Venerology (Skin & VD)
Radiotherapy
Allergy
De-addicon centre
Physical Medicine and Rehabilitaon services
Tobacco Cessaon Services
Dialysis Services
&(0-36()
Services that a District Hospital is expected to provide can be grouped as Essenal
(Minimum Assured Services) and Desirable (which we should aspire to achieve).
The services include OPD, indoor and Emergency Services.
6
123
1 As per guidelines noed by state Government.
2 Standard procedures for medico-legal cases, management of dead body and post mortem services (if needed) to be followed.
3 If the case load of deliveries is more than 75 per month
Lssenna| Des|rab|e
Otorhinolaryngology (ENT)
Orthopaedics
Radiology including Imaging
Psychiatry
Geriatric Services (10 bedded ward)
Health promoon and Counseling Services
@(9<*: 6*0(
District Public Health Unit
@"$ 6(9<0(
AYUSH
Integrated Counseling and Tesng Centre; STI Clinic; ART
!(9<0(
Blood Bank
Disability Cercaon Services
=
Services under Other Naonal Health Programmes
D|agnosnc and other ara c||n|ca| serv|ces regard|ng
Laboratory services including Pathology and Microbiology
Designated Microscopy centre
X-Ray, Sonography
%!>
Endoscopy
Blood Bank and Transfusion Services
Physiotherapy
Dental Technology (Dental Hygiene)
Drugs and Pharmacy
Anc|||ary and support serv|ces
Following ancillary services shall be ensured:
Medico-legal/post mortem
2
7;R?:*96( )(0-36()
Dietary services
Laundry services
Security services
Waste management including Biomedical Waste
Ware housing/central store
'*39<(9*96( *92 0(B*30
Electric Supply (power generaon and stabilizaon)
Water supply (plumbing)
Heang, venlaon and air-condioning
$0*9)B/0<
Communicaon
'(236*: &/63*: N/08
#?0)39+ &(0-36()
CSSD - Sterilizaon and Disinfecon
Horculture (Landscaping)
Refrigeraon
Hospital Infecon Control
F(5(00*: &(0-36()
ost artum Un|t
3
with following services in an integrated
;*99(0
4/)< #*<*: &(0-36()
All Family Planning services i.e Counseling, Tubectomy
(Both Laparoscopic and Minilap), NSV, IUCD, OCPs,
Condoms, ECPs, Follow up services
Safe Aboron Services
Immunizaon
Super Spec|a|nes
(May be provided depending upon the availability of
manpower in State/UT)
Cardiology
Cardio-thoracic and Vascular Surgery
Gastro-enterology
Surgical Gastro-enterology
Plasc Surgery
Electrophysiology
Nephrology
Urology
Neurology
Neurosurgery
Oncology
Endocrinology/Metabolism
Medical oncology
Surgical oncology
Radiaon oncology
#?6:(*0 ;(23639( &B(63*:3)<
D|agnosnc and other ara c||n|ca| serv|ces regard|ng
Blood Bank with all allied facilies
!$ &6*9
'FM
%%>
#!P
%'>
VEP (visual evoked potenal)
Muscle Biopsy
Angiography
Echocardiography
Occupaonal therapy

7
I|nanc|a| powers of nead of the Insntunon: '(236*:
Superintendent to be authorized to incur expenditure
from Rs. 20 lakhs to Rs. 25.00 lakhs depending upon bed
strength for repair/upgrading of impaired equipment/
instruments with the approval of execuve commiee
of Rogi Kalyan Sami/Hospital Management Society.
All equipment should have annual maintenance
6/9<0*6< 5/0 0(+?:*0 )(0-3639+ *92 0(B*30 </ (9)?0(
that they are in opmum working condions and no
equipment/instruments should remain non-funconal
for unreasonably long me. Outsourcing of services
like laundry, ambulance, dietary, housekeeping
and sanitaon, waste disposal etc. should be
preferably arranged by hospital itself. Manpower and
outsourcing work could be done through local tender
mechanism.D
Self evaluaon of hospital services at dened frequency
should be done.
4 Financial accounng and auding be carried out as per the rules
along with mely submission of Statement of Expenditures/Ulizaon
Cercates.
Paent Safety and Infecon Control
Essenal
Hand washing facilies in all OPD clinics, wards,
emergency, ICU and OT areas.
Safe clinical pracces as per standard protocols
to prevent health care associated infecons and
other harms to paents.
There shall be proper wrien handing over
system between health care sta.
Formaon of Infecon control team and
provision of trained Infecon Control nurses.
Hospital shall develop standard operang
procedure for asepc procedures, culture
surveillance and determinaon of hospital
acquired infecons.
Safe Injecon administraon pracces as per
prescribed protocols.
Safe Blood transfusion pracces need to be
implemented by the hospital administrators.
Ensuring Safe disposal of Bio-medical waste as
per rules (Naonal Guidelines to be followed,
may be seen at Annexure II A).
1.
2.
3.
4.
5.
6.
7.
Lssenna| Des|rab|e
Adm|n|stranve serv|ces
(i) Finance
D
(ii) Medical records (Provision should be made for
computerized medical records with an-virus facilies
whereas alternate records should also be maintained)
(iii) Procurement
(iv) Personnel
(v) Housekeeping and Sanitaon
(vi) Educaon and training
(vii) Inventory Management
(viii) Hospital Informaon System
(ix) Grievances redressal Services
Serv|ces under var|ous Nanona| nea|th and Iam||y We|fare
rogrammes.
Lp|dem|c Contro| and D|saster reparedness
Integrated Disease surveillance, epidemic invesgaon and
emergency response
Anc|||ary and support serv|ces
Counseling services for domesc violence, gender violence,
adolescents, etc. Gender and socially sensive service
delivery be assured.
$(:(;(23639(
24 7 ambulance with advance life support systems
Li and vercal transport
Note: Facilies for training of candidates who will be enrolled in the proposed Bachelor of Rural Health Care (BRHC of three and half year) shall be provided,
as per the guidelines, once implemented. As per the proposal, the facilies with more than 300 beds can enroll 50 candidates, and those with 150 to
300 can enroll 25 candidates for the proposed course (BRHC).
8
For Disposal of Mercury, guidelines may be seen
*< Annexure II 8.
Regular Training of Health care workers in
Paent safety, infecon control and Bio-medical
waste management.
Compliance to correct method of hand hygiene
by health care workers should be ensured.
@()30*R:(
Provision of locally made Hand rub soluon in
crical care areas like ICU, Nursery, Burns ward
etc. to ensure Hand Hygiene by Health care
workers at the point of care.
Use of safe Surgery check lists in the ward and
operaon Theatre to minimize the errors during
surgical procedures. (for the detailed checklist
0(5(0 </ Annexure IV).
7 6?:<?0( /5 (96/?0*+39+ 0(B/0<39+ /5
Adverse Events happening in the hospital to
a hospital committee should be developed
to find out the cause of the adverse event
and taking the corrective steps to prevent
them in future. Committee should also have
patient and community representatives as
members.
Guidelines for Airborne Infecon Control as
+3-(9 39 Annexure III should be followed.
Annb|onc o||cy Hospital shall develop its
own anbioc policy to check indiscriminate
use of anbiocs and reduce the emergence of
0()3)<*9< )<0*39).
Health Care Workers Safety
Provision of Protecve gears like gloves, masks,
gowns, caps, personal protecve equipment,
lead aprons, dosimeters etc. and their use
by Health Care workers as per standard
protocols.
Promoon of Hand Hygiene and pracce of
Universal precauons by Health care workers.
Display Standard operang procedures at
strategic locaons in the hospitals.
Implementaon of Infecon control pracces
and Safe BMW Management.
Regular Training of Health care workers in
Universal precauons, Paent safety, infecon
control and Bio-medical waste management.
8.
9.
10.
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
@()30*R:(
Immunizaon of Health care workers against
Tetanus and Hepas B.
Provision of round the clock Post exposure
prophylaxis against HIV in cases of needle scks
injuries.
&(0-36( '3L /5 40/6(2?0() 39 '(236*: *92
Surgical Secialies
./::/139+ )(0-36() ;3L /5 B0/6(2?0() 39 ;(236*: *92
surgical speciales would be available. The list is only
indicave and not exhausve. The diseases prevalent in
the district should be treated.
1.
2.
S|. No. Name of the rocedure
Med|ca|
= Pleural Aspiraon
2 Pleural Biopsy
C Bronchoscopy
D T?;R*0 4?96<?0(
E 4(036*023*: <*BB39+
H Skin scraping for fungus/AFB
J Skin Biopsies
I 7R2/;39*: <*BB39+
O Liver Biopsy
=K Liver Aspiraon
== Fibropc Endoscopy
12 Peritoneal dialysis
=C Hemodialysis
=D Bone Marrow Biopsy
CD rocedures (Inc|ud|ng ID)
= Dressing (Small, Medium and Large)
2 Injecon (I/M & I/V)
C Catheterisaon
D Nebulizaon
E Cut down (Adult)
H %9(;*
J Stomach Wash
I Douche
O Sitz bath
=K !P4 T39(
== Blood Transfusion
12 Hydrotherapy
=C Bowel Wash
Sk|n rocedures
= Chemical Cautery
2 Electro Cautery
9
C Intra Lesional Injecon
D Biopsy
aed|atr|c rocedures
= Immunizaon (As per Naonal Immunizaon
Schedule)
2 Serv|ces re|ated to Newborn care
2.1 - only cradle
2.2 - Incubator
2.3 - Radiant Heat Warmer
2.4 - Phototherapy
2.5 - Gases (Oxygen)
2.6 - Pulse Oxymeter
2.7 - Lumbar Puncture
2.8 - Bone Marrow
2.9 - Exchange Transfusion
2.10 - Cut down
2.11 - Plural/Ascites Tap
2.12 - Venlator
2.13 - Live Biopsy u/s guided
2.14 - Care of LBW newborns <1800 gm
2.15 - Neonatal Resuscitaon
2.16 - Care of Sick New Born
2.17 - Vit K for Premature Babies
2.18 - Antenatal Corcosteroid to mother in case of
B0( <(0; R*R3()
2.19 - Zero Day immunizaon
2.20 - Management of complicaons through SNCU
Card|o|ogy rocedures and D|agnosnc 1ests
= %!>
2 $'$
C A/:<(0
D Thrombolyc Therapy
E !P4 T39(
H Debrilator Shock
J NTG/Xylocard Infusion
I ECHO Cardiography
O Angiography (Desirable)
=K Angiography (Desirable)
Lndoscop|c Spec|a||sed rocedures and D|agnosnc
= Upper GI Endoscopy (Oesophagus, stomach,
duodenum) (Diagnosc and Therapeuc)
2 Sigmoidoscopy and Colonoscopy
C Bronchoscopy and Foreign Body Removal
D Arthros copy (Diagnosc and Therapeuc)
E Laproscopy (Diagnosc and Therapeuc)
H Colposcopy
J Hysteroscopy
sych|atry Serv|ces
= Modied ECT
2 Narcoanalysis
Mk Serv|ces
= W|th L|ectr|ca| Lqu|pment
1.1 - Computerised Tracons (Lumbar & Cervical)
1.2 - Short wave diathermy
1.3 - Electrical Smulator with TENS
1.4 - Electrical Smulator
1.5 - Ultra Sonic Therapy
1.6 - Paran Wax Bath
1.7 - Infra Red Lamp (Therapy)
1.8 - UV (Therapeuc)
1.9 - Electric Vibrator
1.10 - Vibrator Belt Massage
2 W|th Mechan|ca| Gadgets]Lxerc|ses
2.1 - Mechanical Tracons (Lumber & Cervical)
2.2 - Exercycle
2.3 - Shoulder Wheel
2.4 - Shoulder Pulley
2.5 - Supinator Pronator Bar
2.6 - Gripper
2.7 - Visco Weight Cus
2.8 - Walking Bars
2.9 - Post Polio Exercise
2.10 - Obesity Exercises
2.11 - Cerebral Palsy Massage
2.12 - Breathing Exercises & Postural Drainage
C Disability Cercaon Services
Lye Spec|a||st Serv|ces (Cphtha|mo|ogy)
= CD rocedures
1.1 - Refracon (by using snellens chart)
1.2 - Refracon (by auto refrectro meter)
1.3 - Syringing and Probing
1.4 - Foreign Body Removal (conjucval)
1.5 - Foreign Body Removal (Corneal)
1.6 - Epilaon
1.7 - Suture Removal
1.8 - Sub-conjucval Injecon
1.9 - Retrobular Injecon (Alcohol etc.)
10
1.10 - Tonometry
1.11 - Biometry/Keratometry
1.12 - Automated Perimetry
1.13 - Pterygium Excision
1.14 - Syringing & Probing
1.15 - I & C of chalazion
1.16 - Wart Excision
1.17 - Stye
1.18 - Cauterizaon (Thermal)
1.19 - Conjucval Resuturing
1.20 - Corneal Scarping
1.21 - I & D Lid Abscess
1.22 - Uncomplicated Lid Tear
1.23 - Indirect Opthalmoscopy
1.24 - Renoscopy
2 ID rocedures
2.1 - Examinaon under GA
2.2 - Canthotomy
2.3 - Paracentesis
2.4 - Air Injecon & Resuturing
2.5 - Enucleaon with Implant
2.6 - Enucleaion without Implant
2.7 - Perforang Coneo Scleral Injury Repair
2.8 - Cataract Extracon with IOL
2.9 - Glaucoma (Trabeculectomy)
2.10 - Cung of Iris Prolapse
2.11 - Small Lid Turnour Excision
2.12 - Conjucval Cyst
2.13 - Capsulotomy
2.14 - Ant. Chamber Wash
2.15 - Evisceraon
LN1 Serv|ces
= CD rocedures
1.1 - Foreign Body Removal (Ear and Nose)
1.2 - Stching of CLWs
1.3 - Dressings
1.4 - Syringing of Ear
1.5 - Chemical Cauterizaon (Nose & Ear)
1.6 - Eustachian Tube Funcon Test
1.7 - Vesbular Funcon Test/Caloric Test
2 M|nor rocedures
2.1 - Therapeuc Removal of Granulaons (Nasal,
Aural, Oropharynx)
2.2 - Punch Biopsy (Oral Cavity & Oropharynx)
2.3 - Cautrizaon (Oral, Oropharynx, Aural & nasal)
C Nose Surgery
3.1 - Nasal Endoscopy & Endoscopic Sinus Surgery
3.2 - Packing (Anterior & Posterior Nasal)
3.3 - Antral Punchure (Unilateral & Bilateral)
3.4 - Inter Nasal Antrostomy (Unilateral & Bilateral)
3.5 - I & D Septal Abscess (Unilateral & Bilateral)
3.6 - SMR
3.7 - Septoplasty
3.8 - Fracture Reducon Nose
3.9 - Fracture Reducon Nose with Septal Correcon
3.10 - Transantral Procedures (Biopsy, Excision of cyst
and Angiobroma Excision)
3.11 - Transantral Biopsy
3.12 - Rhinoplasty
3.13 - Septoplasty with reducon of turbinate (SMD)
D Lar Surgery
4.1 - Mastoid Abscess I & D
4.2 - Mastoidectomy
4.3 - Stapedotomy
4.4 - Examinaon under Microscope
4.5 - Myringoplasty
4.6 - Tympanoplasty
4.7 - Myringotomy
4.8 - Ear Piercing
4.9 - Hearing Aid Analysis and Selecon
E 1hroat Surgery
5.1 - Adenoidectomy
5.2 - Tonsillectomy
5.3 - Adenoidectomy + Tonsillectomy
5.4 - Tongue Tie excision
H Lndoscop|c LN1 rocedures
6.1 - Direct Laryngoscopy
6.2 - Hypopharyngoscopy
6.3 - Direct Laryngoscopy & Biopsy
6.4 - Broncoscopic Diagnosc
6.5 - Broncoscopic & F B Removal
J Genera| LN1 Surgery
7.1 - Sching of LCW (Nose & Ear)
7.2 - Preauricular Sinus Excision
7.3 - Tracheostomy
11
I Aud|ometry
8.1 - Audiogram (Pure tone and Impedence)
Cbstetr|c & Gyneco|ogy Spec|a||st Serv|ces
= Forceps delivery
2 Craniotomy-Dead Fetus/Hydrocephalus
C Caesarean secon
D Female Sterilizaon (Mini Laparotomy &
Laparoscopic)
E D&C
H MTP (Medical Method & Surgical Methods)
J IUCD services (Inseron & Removal)
Contracepves including emergency
contracepves
I Bartholin Cyst Excision
O &?<?039+ 4(039(*: $(*0)
=K Ovarian Cystectomy/Oophrectomy
== Vaginal Hysterectomy
12 Haematocolpes Drainage Colpotomy
=C Caesarian Hysterectomy
=D Assisted Breech Delivery
=E Cervical Biopsy
=H Cervical Cautery (Electro/cryocautery)
=J Normal Delivery
=I 44$!$
=O %U7
20 Midtrimestor Aboron
21 Ectopic Pregnancy Ruptured Rupteured &
U90?B<?0(2
22 F(<*39 4:*6(9<*
23 &?<?039+ !(0-36*: $(*0
24 Assisted Twin Delivery
25 Colposcopy
26 Hysteroscopy
27 Laparoscopy Diagnosc/Operave
28 Vaccum Delivery
29 Endometria Biospsy
CK %!!
C= Cervical Biopsy
32 Endomeral Aspiraon
CC Hysterotomy
CD Sling Operaon
CE Tuboplasty
CH Emergency & Exploratory Laparotomy (Uterine
perforaon, sepc aboron, Twisted Ovarian,
Pelvic abscess, ectopic pregnancy)
CJ .#7!
CI '*9*+(;(9< /5 &(-(0( 79*(;3*
Denta| Serv|ces
= Dental Caries/Dental Abscess/Gingivis
2
Periodons
!:(*939+
Surgery
C Minor Surgeries, Impacon, Flap
D '*:/66:?)3/9
E Prosthodona (Prosthec Treatment)
H Trauma including Vehicular Accidents
J '*L3::/ .*63*: &?0+(03()
I #(/B:*);)
O Sub Mucus Fibrosis (SMF)
=K Scaling and Polishing
== F//< !*9*: $0(*<;(9<
12 Extracons
=C Light Cure
=D Amalgum Filling (Silver)
=E Sub Luxaon and Arthris of Temporomandibular
Joints
=H 40( !*96(0/?) T()3/9) *92 T(?8/B:*83*)
=J Intra oral X-ray
=I .0*6<?0( 13039+
=O Apiscectomy
20 Gingivectomy
21 Removal of Cyst
22 Complicated Extracons (including suturing of gums)
Surg|ca|
= Abscess drainage including breast & perianal
2 N/?92 @(R032(;(9<
C Appendicectomy
D Fissurotomy or stulectomy
E Hemorrohoidectomy
H !306?;63)3/9
J Hydrocele surgery
I Herniorraphy
O Suprapubic Cystostomy
=K Urethral Dilataon
12
== Cystoscopy
12 Endoscopy
=C Diagnosc Laparoscopy
=D Colonoscopy
=E Sigmoidoscopy
=H Colposcopy
=J Hysteroscopy
=I Arthroscopy
=O Tonsillectomy
20 Mastoidectomy
21 Stapedotomy
22 Craniotomy (Neurosurgical)
23 Forceps delivery
24 Craniotomy-Dead Fetus/Hydrocephalus
25 Caesarean secon
26 Female Sterilizaon (Mini Laparotomy &
Laparoscopic)
27 Vasectomy
28 D&C
29 '$4
CK .#7!
C= Supercial & Total Parodectomy
32 Intra-oral removal of submandibular duct
!*:6?:/?)
CC Excision Branchial Cyst or Fistula/sinus
CD Excision of Lingual Thyroid
CE Hemithyroidectomy (Sub total Thyroidectomy/
Lobectomy)
CH Cysts and Benign Tumour of the Palate
CJ Excision Submucous Cysts
8reast
= Excision broadenoma Lump
2 Simple Mastectomy
C Modied Radical Mastectomy
D Sectoral Mastectomy/Microdochectomy/
Lumpectomy
E Wedge Biopsy
H Excision Mammary Fistula
nern|a
= M9+?93*: A(093* 0(B*30
2 Ingunial Hernia repair with mesh
C .(;/0*: A(093* 0(B*30
D %B3+*)<036VP(9<0*: A(093* 0(B*30
E F(6?00(9< M9+?93*: A(093* 0(B*30
H Ventral Hernia repair with mesh
J Operaon of Strangulated Ventral, Inguinal or
M963)3/9*: A(093*
I F(6?00(9< M963)3/9*: A(093* F(B*30
O Diaphragmac Hernia Repair
Abdomen
= Exploratory Laparotomy
2 Gastrostomy or Jejunostomy
C &3;B:( !:/)?0( /5 4(05/0*<(2 U:6(0
D Ramstedts Operaon
E Gastro-Jejunostomy
H Vagotomy & Drainage Procedure
J Adhesonolysis or division of bands
I Mesenteric Cyst
O F(<0/B(03</9(*: $?;/?0 %L63)3/9
=K Intussucepon (Simple Reducon)
== Burst Abdomen Repair
Sp|een and orta| nypertens|on
= Splenectomy
ancreas
= Drainage of Pseudopancreac Cyst
(Cystogastrectomy)
2 F(<0/B(03</9(*: @0*39*+( /5 7R)6())
Append|x
= Emergency Appendicectomy
2 Interval Appendicectomy
C 7BB(9236?:*0 7R)6()) @0*39*+(
Sma|| Intesnne
= Resecon and Anastomosis
2 Intussuscepon
C Intesnal Fistula
D Mulple Resecon and Anaestomosis
E Intesnal Performaon
L|ver
= "B(9 @0*39*+( /5 :3-(0 *R)6())
2 Drainage of Subdiaphragmac Abscess/Perigastric
7R)6())
C Hydad Cyst Excision
8|||ary System
= Cholecystostomy
2 Cholecystectomy: Open and Laparoscopic
13
C Cholecystectomy, Choledocholithotomy &
Choledochoduodenostomy
Co|on, kectum and Anus
= .3)<?:* 39 *9/ :/1 :(-(:
2 Fistula in ano high level with Stenosis
C Colostomy
D 4(03*9*: 7R)6()) @0*39*+(
E Ischiorectal Abscess
H Ileostomy or colostomy alone
J Sigmoid Myotomy
I Right Hemicolectomy
O Sigmoid & Descending Colectomy
=K Haemorrhoidectomy
== Sphincterotomy and Fissurectomy
12 Tube Caecostomy
=C Closure of loop colostomy
=D F(6<*: 40/:*B)( F(B*30
=E Anal Sphincter Repair aer injury
=H Thierschs operaon
=J P/:-?:?) /5 6/:/9
=I Resecon anastomosis
=O Imperforate anus with low opening
20 43:/932*: &39?)
en|s, 1estes, Scrotum
= !306?;63)3/9
2 Paral amputaon of Penis
C Total amputaon of Penis
D Orchidopexy (Unilateral & Bilateral)
E Orchidectomy (Unilateral & Bilateral)
H Hydrocele (Unilateral & Bilateral)
J Excision of Mulple sebaceous cyst of scrotal skin
I Reducon of Paraphimosis
Cther rocedures
= Suturing of large laceraon
2 &?<?039+ /5 );*:: 1/?92)
C Excision of sebaceous cyst
D Small supercial tumour
E Large supercial tumour
H Repair torn ear lobule each
J M963)3/9 *92 20*39*+( /5 *R)6())
I Lymph node biopsy
O Excision Biopsy of supercial lumps
=K Excision Biopsy of large lumps
== Injecon Haemorrhoids/Ganglion/Keloids
12 Removal of foreign body (supercial)
=C Removal of foreign body (deep)
=D Excision Biopsy of Ulcer
=E Excision Mulple Cysts
=H Muscle Biopsy
=J $/9+?( $3(
=I @(R032;(9< /5 1/?92)
=O %L63)3/9 6*0R?96:(
20 M9+0/-39+ $/( #*3:
21 Excision So Tissue Tumour Muscle Group
22 Diabec Foot and carbuncle
Uro|ogy
= Pyelolithotomy
2 Nephrolithotomy
C Simple Nephrostomy
D Implantaon of ureters
E Vesico-vaginal stula
H Nephrectomy
J Uretrolithotomy
I Open Prostectomy
O Closure of Uretheral Fistula
=K Cystolithotomy Suprapubic
== Dilataon of stricture urethra under GA
12 Dilataon of stricture urethra without anaesthesia
=C Meatotomy
=D Tescular Biopsy
=E Trocar Cystostomy
|asnc Surgery
= Burn Dressing Small, medium (10% to 30%), large
30% to 60%, extensive > 60%
2 Ear lobules repair one side (bilateral)
C &3;B:( 1/?92
D !/;B:36*<(2 1/?92
E Face Scar Simple
H Cle Lip One side
J Small wound skin gra
I Simple injury ngers
O Finger injury with skin gra
=K Mulple ngers injury
== Crush injury hand
14
12 Full thickness gra
=C Congenial Deformity (Extra digit, Syndactly,
Constricon rings)
=D Reconstrucon of Hand (Tendon Repair)
=E Polio Surgery
=H Surgery concerning disability with Leprosy
=J Surgery concerning with TB
aed|atr|c Surgery
= Minor Surgery, I & D, Prepuceal Dilataon,
Meatotomy
2 Gland Biopsy, Reducon Paraphimosis, small so
Tissue tumour (Benign)
C Rectal Polyp removal, deep abscess
D Big so ssue tumour
E Branchial cyst/stula/sinus, Throglossal cyst and
stula
H Ingunial Herniotomy (Unilateral & Bilateral)
J Orchidopexy (Unilateral & Bilateral)
I Pyloric Stenosis Ramstad operaon
O Exploratory Laprotomy
=K Neonatal Intesnal Obstrucon/Resecon/Atresia
== Gastrostomy, colostomy
12 U;R3:36*: A(093*V%B3+*)<036 A(093*
=C Sacrocaccygeal Teratoma
=D Torsion of Tess
=E Hypospadius single stage (rst stage)
Crthopaed|c Surgery
= n|p Surgery
2 Femoral Neck nailing with or without plang
replacement prosthesis/Upper Femoral Osteotomy;
Innominate Osteotomy/Open Reducon of Hip
disclocaon; DHS/Richard Screw Plate
C Synovial or bone biopsy from Hip
D Girdle stone Arthoplasty
E Arthroscopy
H Total Hip Replacement (Desirable)
J Total Knee Replacement (Desirable)
Iractures
= Open reductuin int. xaon or femur, bia,
B. Bone, Forearm Humeras inter-condylar fracture
of humerus and femur and open reducon
and int. Fixaon bimaleolar fracture and
fracture dislocaon of ankle montaggia fracture
dislocaon
2 Medical concyle of humerus, fracture lateral
condyle of humerus, Olecranen fracture, head of
radius lower end of radius, medial malleolus patella
50*6<?0( *92 50*6<?0( /5 6*:6*9(?; <*:?) )39+:(
forearm, bone fracture
C External Fixaon Applicaon Pelvis femur, bia
humerus forearm
D Ext. xaon of hand & foot bones
E Tarsals, Metatarsals, Phalanges carpals,
Metacarples, excision head bula, lower end of
?:9*
H @0*39*+( /5 50*6<?0(
J M9<(0:/6839+ 9*3:39+ /5 :/9+ R/9()
I Debridement & Secondary closure
O Percutaneous Fixaon (small and long bones)
C|osed keducnon
= Hand, Foot bone and cervical
2 Forearm or Arm, Leg, Thigh, Wrist, Ankle
C Dislocaon elbow, shoulder, Hip, Knee
D Closed Fixaon of hand/foot bone
Cpen keducnon and Cthers
= Shoulder dislocaon, knee dislocaon
2 Acromiocalvicular or stemoclavicular Jt., Clavicle
C Ankle Bimalleolar Open reducon, Ankle
Trimalleolar open reducon
D Wrist dislocaon on intercarpal joints
E MP & IP Joints
H Knee Synovectomy/Menisectomy
J Fasciotomy leg/forearm
I High Tibial Osteotomy
O Arthodesis (Shoulder/Knee Ankle, Triple/elbow,
Wrist/Hip)
=K Arthodesis MP & IP Joints
== Excision Exostosis long bones, single/two
12 Curretage Bone Graing of Bone Tumour of
femur/bia Humerus & forearm
=C Surgery tumours of small bone hand and foot
=D Debridement primary closure of compounds
fracture of bia, femur forearm without xaon
=E Debridement of hand/foot
=H Debridement primary closure of compound
fractures of bia, femur forearm with xaon
=J Tendon surgery so ssue release in club foot
=I Internal xaon of small bone (Single, Two, More
than two)
15
=O Tendon Surgery (Repair and Lengthening)
20 Surgery of chronic Osteomyelis (Saucerizaon,
Sequentrectomy of femur, Humerus, Tibia)
21 Fibula Radius Ulna (Clavicle) and Wrist, Ankle,
A*92 5//<
22 Amputaon (Thigh or arm, leg or forearm, feet or
hand, digits)
23 Disarculaon of hip or shoulder (Disarculaon
of knee elbow/wrist/ankle; Fore-quarter or
hind-quarter)
24 POP Applicaon (Hip Spica, Shoulder spica POP
Jacket; A-K/A-E POP; B-K/B-E POP)
25 Correcve Osteotomy of long bones
26 Excision Arthoplasty of elbow & other major
joints; Excision Arthoplasty of small joints
27 Operaon of hallus valgus
28 Bone Surgery (Needle biopsy, Axial Skelton,
Non-Axial)
29 F(;/-*: S #*3: 7" 4:*<()
CK Removal Forearm Nail, Screw, Wires
C= Skeletal Tracon Femur, Tibia, Calcanium, Elbow
32 Bone Graing (small graing and long bone)
CC Ingrowing toe-nail
CD So ssue Biopsy
CE Skin Gra (small, medium and large)
CH Patellectomy
CJ Olacranon xaon
CI Open Ligament repair of elbow, Ankle & Wrist
CO Arthrotomy of hip/shoulder/elbow
DK !*0B*: $?99(: F(:(*)(
D= Dupuytrens contracture
42 Synovectomy of major joint shoulder/hip/Elbow
DC F(B*30 /5 :3+*;(9<) /5 89((
DD !:/)(2 #*3:39+ /5 :/9+ R/9()
DE External xator readjustment dynamisaon
removal of external xaon/removal of implant
DH Excision of so ssue tumour muscle group
S|. No. Name of the I||ness kecommended Serv|ce M|x
(suggested acnons)
= Bleeding during rst trimester & nyperemes|s $0(*<
2 Bleeding during second trimester $0(*<
C Bleeding during third trimester (An]|acenta rev|a) Treat & refer if Necessary
C* |acenta Accreta]|ncreta]percreta Invesngate and refer |f necessary
D Normal Delivery (Inducnon of |abor) Yes
E Abnormal labour (Mal presentaon, prolonged labour,
re-1erm Labour, IUGk, Ma| os|non, Cord ro|apse
PROM, Obstructed labour)
$0(*<
H 44A $0(*<
J 4?(0B(0*: &(B)3) $0(*<
I Ectopic Pregnancy $0(*<
O nypertennve d|sorders (Severe preec|amps|a &
Lc|amps|a)
Invesngate, treat and refer |f necessary
Recommended Service Mix (suggested acons) for dierent illnesses concerning dierent
specialies
Obstetric and Gyneacology
16
(suggested acnons)
=K Sepc aboron & Incomp|ete Abornon $0(*<
== Medical disorders complicang pregnancy (heart
disease, diabetes, hepas, kena| d|sorders,
kesp|tatory D|sorders, 1ubercu|os|s, Anem|a, kn
neganve regnancy)
12 8ronch|a| asthma 1reat
=C Gestanona| 1rophob|asnc d|seases Invesngate, treat and refer |f necessary
=D Intra-Uter|ne Death Invesngate, treat and refer |f necessary
=E Surg|ca| D|sorders w|th pregnancy (rev. LSCS]I|bro|d
uterurs]Cvar|an mass)
=H 8|eed|ng D|sorders |n regnacy kefer at the ear||est
Gynaeco|ogy
= F$MV&$M $0(*<
2 Dysfunconal Uterine Bleeding $0(*<
C Benign disorders (broid, prolapse, ovarian masses
& 1ors|on, endometr|os|s)
Inial invesgaon at PHC/Gr III level
$0(*<
D Breast Tumors Invesgate, treat and refer if necessary
E !*96(0 !(0-3L Lndometr|a|, Cvar|an, Vu|va|, Vag|na|
screen|ng
Inial invesgaon at PHC/Grade III level
Collecon of PAP SMEAR and biopsy, Endometrial
Aspiraon, ECC, D&C, Colposcopy, hysteroscopy
kepa|r|ng Cyto|ogy & n|spotha|ogy
H Cancer cervix/ovarian Inial invesgaon at PHC/Gr III
:(-(:
$0(*<
J Inferlity $0(*<
I Prevenon of MTCT 40(<()< *92 B/)< <()< *92 6/?9)(::39+ *92 <0(*<;(9<
O '$4V'P7 )(0-36() $0(*<
=K Tubectomy (M|n|-|ap, Laparoscop|c) Yes
== Medico-Legal Cases (Rape, Sexual Assault) Registraon, Examinaon, Sample collecon, Treat,
Provision of emergency contracepon
(as per Supreme Court order)
S|.
No.
Name of the I||ness kecommended Serv|ce M|x
(suggested acnons)
= Fever a) Short duraon (<1 week) Basic invesgaon and Treatment
b) Long duraon (>1 week) Invesgaon and treatment
c) Typhoid $0(*<
d) Malaria/Filaria. $0(*<
e) Pulmonary Tuberculosis. $0(*<
f) Viral Hepas $0(*<
If HBs, Ag +ve refer to terary care
g) Leptospirosis/Meningis and Haemorrhagic fever Conrm by MAT/CSF Analysis and treat
h) Malignancy Conrm diagnosis refer to terary care
>(9(0*: '(23639(
17
S|.
No.
(suggested acnons)
2 Common kesp|ratory I|nesses
Bronchial Asthma/Pleural eusion/Pneumonia/
Allergic Bronchis/COPD
@3*+9/)( *92 $0(*<
C Common Card|ac rob|ems
a) Chest pain (IHD) Treat and decide further management
b) Giddiness (HT) @3*+9/)( *92 <0(*<
D G I 1ract
a) G I Bleed/Paral hypertension/Gallbladder disorder Invesgate and treat
b) AGE/Dysentery/Diarrhoreas $0(*<
E Neuro|ogy
a) Chronic Headache Invesgate, treat & decide further
b) Chronic Vergo/CVA/TIA/Hemiplegia/Paraplegia $0(*<
H naemato|ogy
a) Anaemia Basic invesgaon and Treatment
b) Bleeding disorder &<*R3:3)(
Ref. To terary
c) Malignancy Treat & decide further
J Commun|cab|e D|seases
Cholera
'(*):()
'?;B)
Chickenpox
$0(*<
I sycho|og|ca| D|sorders
Acute psychosis/Obsession/Anxiety neurosis $0(*<
O o|son|ngs '*9*+(;(9<
Naonal Poisoning Centre (at AIIMS,New Delhi) may be
consulted if required. Poisoning centers at state level
with helpline numbers may be established to guide the
;*9*+(;(9<
S|.
No.
(suggested acnons)
= ARI/Bronchis Asthmac Invesgate
@3*+9/)(
Nebulizator Oxygen
2 Diarrohoeal Diseases @3*+9/)(
$0(*<
"F$ !(9<(0
4*(23*<036)
18
S|.
No.
(suggested acnons)
C Protein Energy Malnutrion and Vitamin Deciencies Invesgate, then refer & then supporve treatment in
liaison with the specialized centre
@3*+9/)(
Treat with help of Diecian
D Pyrexia of unknown origin @3*+9/)(
$0(*<
E Bleeding Disorders Invesgate & Treat
H Diseases of Bones and Joints Invesgate & Treat
J Childhood Malignancies Invesgate then refer & then supporve treatment in
liaison with the specialized centre & manage
I T3-(0 @3)/02(0) Invesgate & Manage
O 4*(23*<036 &?0+36*: %;(0+(963() Invesgate & Manage
=K Poisoning, Sng, Bites $0(*<
Neonatology
S|.
No.
Name of 1he I||ness kecommended Serv|ce M|x
(suggested acnons)
= Aenon at birth (to prevent illness) 5 cleans warm chain
2 Hypothermia Warm chain
C Birth asphyxia Resuscitaon And Treatment
D Hypoglycemia Invesgate & Treat
E Meconium aspiraon syndrome $0(*<
H Convulsions (seizures) Invesgate & Treat
J #(/9*<*: &(B)3) Invesgate & Treat
I LBW Invesgate & Treat
O Neonatal Jaundice $0(*<
=K 40(<(0; Warm chain, feeding, kangaroo care, Treat
== Congenital malformaons '*9*+(
12 R.D.S. ARI Manage, CPAP
=C Seriously ill baby Idenfy and manage & refer appropr|ate|y
=D .((239+ 40/R:(;) Idenfy and manage
=E Neonatal diarrhoea @3*+9/)3) *92 ;*9*+(
=H Birth injury '*9*+(
=J Neonatal Meningis '*9*+(
=I
Renal problems/Congenital heart disease/Surgical
(;(0+(963()
F(5(0
=O AMPV7M@& Exclusive breast feeding & manage
20 Hypocalcemia '*9*+(
21 '(<*R/:36 @3)/02(0) '*9*+(
22 Hyaline Membrane diseases Diagnose & treat with CPAP
23 #(/9*<*: '*:*03* '*9*+(
24 Blood disorders '*9*+(
25 Developmental Delays CBR
26 U$M) Manage & refer
27 Failure to Thrive Manage & Refer
19
S|.
No.
Name of 1he I||ness kecommended Serv|ce M|x
(suggested acnons)
= Infecnons
a) V|ra| - HIV - Verrucca
'/::?)6?; !/9<*+3/)*
Pityriasis Rosea
T>P
AMP
$0(*<
b) 8acter|a
Pyoderma
Chancroid
Gonorrhea
Leprosy
$?R(06?:/)3)
$0(*<
c) Iunga|
Sup. Mycosis
Subcut - Mycetoma
$0(*<
2) aras|nc Infestanon
&6*R3()V4(236?:/)3)VT*0-* '3+0*9)
$0(*<
e) Sp|rochaetes
Syphilis
@3*+9/)3) *92 $0(*<
2 apu|osquamous
Psoriasis (classical)-uncomplicated/Lichen Planus
$0(*<
C |gmentary D|sorder
Viligo
$0(*<
D kerann|sanon D|sorder
Ichthyosis/Traumac Fissures
$0(*<
E Auto|mmune
!/::*+(9 P*)6?:*0
DLE, Morphea
$0(*<V
F(5(0
H Sk|n 1umors, Seb. Keratosis, So Fibroma, Benign
Surface, Tumors/Cysts, Appendageal Tumors
$0(*<
J M|sce||aneous
a) Acne Vulgaris, Miliaria, Alopecia, Nail disorder, Toxin
392?6(2
$0(*<
b) Leprosy - Resistant/
Complicaons/reacon
Allergy - EMF/SJS/TEN Psoriasis/Collagen Vascular/
7?</ 3;;?9( @3)/02(0)
$0(*<
c) Deep Mycosis, STD Complicaons $0(*<
d) Genecally Determined
@3)/02(0)
$0(*<
Dermatology
20
S|. No. Name of 1he I||ness kecommended Serv|ce M|x
(suggested acnons)
= .(-(0 Invesgaon and Treatment
2 Cough with Expectoraon/Blood Stained Treatment CT Scan if necessary
C Hemoptysis CT scan Bronchoscopy Treatment
D Chest Pain Invesgaon and Treatment
E Wheezing Treatment, PFT
H Breathlessness Invesgaon and Treatment
Chest Physiotherapy
Chest Diseases
(suggested acnons)
= Schizophrenia $0(*<;(9< *92 ./::/1 ?B
If Possible (IP) Management
2 Aecve/Bipolar disorders $0(*<;(9< *92 ./::/1 ?B
C "R)())3-( 6/;B?:)3-( 23)/02(0) $0(*<;(9< *92 ./::/1 ?B
D Anxiety Disorders $0(*<;(9< *92 ./::/1 ?B
E Childhood Disorders including Mental Retardaon $0(*<;(9< *92 ./::/1 ?B
H &/;*</5/0; *92 6/9-(0)3/9 23)/02(0) $0(*<;(9< *92 ./::/1 ?B
J Alcohol and Drug Abuse $0(*<;(9< *92 ./::/1 ?B
I Demena $0(*<;(9< *92 ./::/1 ?B
Psychiatry
S|. No. Name of the I||ness
kecommended Serv|ce M|x
(suggested acnons)
= @3*R(<() Screening, Diagnose and Treat
2 Gestaonal Diabetes/DM with Pregnancy @3*+9/)( *92 $0(*<
C DM with HT Screening, Diagnose and Treat
D Nephropathy/Renopathy @3*+9/)( *92 $0(*<
E Neuropathy with Foot Care @3*+9/)( *92 $0(*<
H
Emergency :-
i) Hypoglycemia
ii) Ketosis
iii) Coma
@3*+9/)( *92 $0(*<
Diabetology
21
(suggested acnons)
= U96/;B:36*<(2 U$M $0(*<
2 Nephroc Syndrome - Children/Acute Nephris $0(*<
C Nephroc Syndrome - Adults Refer to Terary, follow up care
D HT, DM $0(*<
E Asymptomac Urinary Abnormalies $0(*<
H Nephrolithiasis $0(*<
J Acute Renal Failure/Chronic Renal Failure $0(*<
I $?;/0) Refer to Terary
Nephrology
(suggested acnons)
= Epilepsy Invesgate and Treat
2 C. V. A. Invesgate and Treat
C Infecons Invesgate and Treat
D $0*?;* Invesgate and Treat
E Chronic headache Invesgate and Treat
H Chronic Progressive Neurological disorder Invesgate and Treat
Neuro Medicine and Neuro Surgery
(suggested acnons)
= 8as|c 1echn|ques a. M|nor Cases
under LA Abscess I&D/Suturing, Biopsy/Excision
of Lipoma/Ganglion/Lymph Node/Seb-Cyst/
@(0;/32V%*0 T/R( F(B*30V!306?;63)3/9
$0(*<
b. FNAC Thyroid, Breast Lumps, Lymphnodes,
&1(::39+
Invesgate/Diagnosis/Treatment
2 L|ecnve Surger|es a. Gen|tour|nary tract Hydrocele, Hernia,
Circumcision, Supra pubic cysostomy
$0(*<
b. Gastro|ntesnna| d|sorder Appendicis/
79/0(6<*: *R6())()VF(6<*: B0/:*B)(VT3-(0
abscess/Haemorrhoids/Fistula
$0(*<
C Lmergency Surger|es Assault injuries/Bowel injuries/Head injuries/
Stab injuries/Mulple injuries/Perforaon/
Intesnal obstrucon
$0(*<
D 8en|gn]Ma||gnant
D|seases
Breast/Oral/GI tract/Genitourinary (Penis,
Prostate, Tess)
$0(*<
E Cthers 1hyro|d, Var|cose ve|ns $0(*<
H 8urns 8urns
< 15%
>15%
$0(*<
$0(*<
General Surgery
22
(suggested acnons)
J Med|co |ega| a) Assault/RTA AR Entry/Treat
b) Poisonings AR Entry/Treat
c) Rape AR Entry/Treat
d) Postmortem $/ R( @/9(
(suggested acnons)
= Supercial Infecon Treatment with drugs
2 Deep Infecons $0(*<
C Refracve Error $0(*<
D >:*?6/;* $0(*<
E Eye problems following systemic disorders $0(*<
H !*<*0*6< $0(*<
J Foreign Body and Injuries $0(*<
I
Squint and Amblyopia/Corneal Blindness (INF, INJ,
Leucoma)/Oculoplasty
$0(*<
O Malignancy/Rena Disease $0(*<
=K Paediatric Opthalmology $0(*<
Opthalmology
(suggested acnons)
Lar
= 7&"'V&"'V!&"' $0(*<V&?0+36*: 35 9((2(2
2 Os External/Wax Ears $0(*<
C Polyps &?0+36*: $0(*<;(9<
D Mastoidis $0(*<;(9<
Surgery if needed
E U9)*5( %*0 Surgery
1hroat
= Tonsillis/Pharyngis/Laryngis $0(*<
2 Quinsy Surgery
C Malignancy Larynx Biopsy/Treat
D Foreign Body Esophagus Treat (removal)
E Foreign Body Bronchus $0(*<
Ear, Nose, Throat
23
(suggested acnons)
Nose
= %B3)<*L3) $0(*<
2 Foreign Body $0(*<
C Polyps Treat (Removal)
D Sinusis Treat (surgery if needed)
E Septal Deviaon Treat (surgery if needed)
(suggested acnons)
= Osteo-myelis Surgery
2 Rickets/Nutrional Deciencies Manage with Physiotherapy
C Poliomyelis with residual Deformies/JRA/RA Joint Replacement/Rehab for Polio
D RTA/Poly trauma '*9*+(
Orthopadics
(suggested acnons)
Ch||dren
= Hydronephrosis @3*+9/)( *92 0(5(0
2 Urinary Tract Injuries @3*+9/)( *92 0(5(0
C (PUV)/Posterior Urethral Valve @3*+9/)( *92 0(5(0
D Cysc Kidney @3*+9/)( *92 0(5(0
E Urinary Obstrucon Urethrral Catheter Inseron SPC and Referral
H Undesended Tess @3*+9/)( *92 0(5(0
J Hypospadias and Epispadias @3*+9/)( *92 0(5(0
I '(+* U0(<(0 @3*+9/)( *92 0(5(0
O Extrophy @3*+9/)( *92 0(5(0
=K Tumours - Urinary Tact @3*+9/)( *92 0(5(0
Adu|t
7:: *R/-( *92
= Stricture Urethra $0(*<;(9<
2 &</9( @3)(*)() $0(*<;(9<VF(5(00*:
C Cancer - Urinary and Genital Tract $0(*<;(9<VF(5(00*:
D Trauma Urinary Tact $0(*<;(9<VF(5(00*:
E Genito Urinary TB $0(*<;(9<VF(5(00*:V./::/1 ?B
C|d Age
= Prostate Enlargement and Urinary Retenon $0(*<;(9<VF(5(00*:
2 Stricture Urethra $0(*<;(9<
C &</9( $0(*<;(9<VF(5(00*:
D !*96(0
(Kidney, Bladder, Prostate, Tess, Penis and Urethra)
$0(*<;(9<VF(5(00*:
E Trauma Urinary Tract $0(*<;(9<VF(5(00*:
Urology
24
(suggested acnons)
= Dental Caries/Dental Abscess/Gingivis $0(*<
2
Periodons
!:(*939+
Surgery
$0(*<
C Minor Surgeries, Impacon, Flap $0(*<
D '*:/66:?)3/9 Treat with appliances
E Prosthodona (Prosthec Treatment) Treat with appliances
H $0*?;* Treat (wiring and plang)
J '*L3::/ .*63*: &?0+(03() $0(*< *92 0(5(0
I #(/B:*);) Treat and Refer if necessary
Dental Surgery
(suggested acnons)
= CHD/M.I. Counselling/Diet advice Safe Life Style changes
2 @3*R(<() Life Style Modicaons/Physiotherapy
C &?R)<*96( 7R?)( Vocaonal Rehabilitaon Safe Style
D AMPV7M@& AMP !/?9)(::39+
E $/R*66/3); Tobacco cessaon
Health Promoon and Counselling
(suggested acnons)
= Communicable & Vaccine Preventable Diseases Health Promoonal Acvies like ORT Canon,
Immunizaon Camps
2 Non-communicable Diseases Epidemiological Health Invesgaon, Promoon &
Counselling Acvies
C Adolescent & School Health Adolescent & school health promoonal acvies
D Family Planning Counselling services, camps, follow up of contracepve
?)(0)
E AMPV7M@& HIV Counseling and Tesng; STI tesng; Blood safety;
ART, Training
Community Health Services
Physical Infrastructure
Size of the hospital
The size of a district hospital is a funcon of the hospital
bed requirement which in turn is a funcon of the size of
the populaon it serves. In India the populaon size of a
district varies from 50,000 to 15,00,000. For the purpose
of convenience the average size of the district is taken in
this document as one million populaon. Based on the
assumpons of the annual rate of admission as 1 per 50
populaon and average length of stay in a hospital as
5 days, the number of beds required for a district having
a populaon of 10 lakhs will be as follows:
25
The total number of admissions per year
= 10,00,000 1/50 = 20,000
Bed days per year = 20,000 5 = 100,000
Total number of beds required when occupancy is
100% = 100000/365 = 275 beds
Total number of beds required when occupancy is
IKW X =KKKKKVCHE IKV=KK
= 220 beds
F(G?30(;(9< /5 R(2) 39 * @3)<036< A/)B3<*: 1/?:2 *:)/ R(
determined by following factors:
Urban and Rural demographics and likely
R?02(9 /5 23)(*)()
Geographic terrain
Communicaon network
Locaon of FRUs and Sub-district Hospitals in
the area
Nearest Terary care hospital and its distance
& travel me
Facilies in Private and Not-for prot sectors
Health care facilies for specialised populaon
Defence, Railways, etc.
Area and Space norms of the hospital
T*92 70(*
(Desirable)
Minimum Land area requirement are as follows:
Upto 100 beds = 0.25 to 0.5 hectare
Upto 101 to 200 beds = 0.5 hectare to 1 hectare
500 beds and above = 6.5 hectare (4.5 hectare for
hospital and 2 hectare for residenal)
Size of hospital as per number of Beds
a. Genera| nosp|ta| - IK </ IE )G; B(0 R(2 </ 6*:6?:*<(
total plinth area. (Des|rab|e).
The area will include the service areas such as waing
space, entrance hall, registraon counter etc. In
addion, Hospital Service buildings like Generators,
Manifold Rooms, Boilers, Laundry, Kitchen and essenal
sta residences are required in the Hospital premises.
In case of specic requirement of a hospital, exibility
in altering the area be kept.
b. 1each|ng nosp|ta| - =KK </ ==K )G; B(0 R(2 </
calculate total plinth area.
a.
b.
c.
d.
e.
f.
g.
Following facilies/area may also be considered
while planning hospital.
(Desirable)
(i) Operaon Theatre a. One OT for every 50
general in-paent beds
b. One OT for every 25
surgical beds.
(ii) M!U R(2) X E </ =K W /5 </<*: R(2)
(iii) Floor space for each ICU
R(2
= 25 to 30 sq m (this includes
support services)
(iv) .://0 )B*6( 5/0
4*(23*<036 M!U R(2)
= 10 to 12 sq m per bed
(v) Floor space for High
Dependency Unit (HDU)
= 20 to 24 sq m per bed
(vi) .://0 )B*6( A/)B3<*:
beds (General)
X =E </ =I )G ; B(0 R(2
(vii) Beds space = 7 sq m per bed.
(viii) '393;?; 23)<*96(
R(<1((9 6(9<0() /5 <1/
R(2)
= 2.5 m (minimum)
(ix) !:(*0*96( *< 5//< (92 /5
each bed
= 1.2 m (minimum)
(x) Minimum area for
apertures (windows/
Venlators opening in
fresh air)
= 20% of the oor area
(if on same wall)
= 15% of the oor area
(if on opposite walls)
Site selecon criteria
In the case of either site selecon or evaluaon of
adaptability, the following items must be considered:
Physical descripon of the area which should include
bearings, boundaries, topography, surface area, land
used in adjoining areas, drainage, soil condions,
limitaon of the site that would aect planning, maps
of vicinity and landmarks or centers, exisng ulies,
nearest city, port, airport, railway staon, major bus
stand, rain fall and data on weather and climate.
Factors to be considered in locang a district
hospital
The locaon may be near the residenal area.
Too old building may be demolished and new
construcon done in its place.
It should be free from dangers of ooding; it
must not, therefore, be sited at the lowest point
of the district.

26
It should be in an area free of polluon of
any kind including air, noise, water and land
polluon.
It must be serviced by public ulies: water,
sewage and storm-water disposal, electricity
and telephone. In areas where such ulies are
not available, substutes must be found, such as
a deep well for water, generators for electricity
and radio communicaon for telephone.
Necessary environmental clearance will be
taken.
Site selecon Process
A raonal, step-by-step process of site selecon
occurs only in ideal circumstances. In some cases, the
availability of a site outweighs other raonal reasons for
its selecon, and planners and architects are confronted
with the job of assessing whether a piece of land is
suitable for building a hospital.
In the already exisng structures of a
district hospital
It should be examined whether they t into
the design of the recommended structure
and if the exisng parts can be converted into
funconal spaces to t in to the recommended
standards.
If the exisng structures are too old to become
part of the new hospital, could they be conver-
ted to a motor pool, laundry, store or workshop
or for any other use of the district hospital.
If they are too old and dilapidated then they
must be demolished. And new construcon
should be put in place.
Hospital Building Planning and Lay out
Hospital Management Policy should emphasize on
hospital buildings with earthquake proof, ood proof
and re protecon features. Infrastructure should
be eco-friendly and disabled (physically and visually
handicapped) friendly. Local agency Guidelines and By-
laws should strictly be followed.
i) Appearance and upkeep
The hospital should have a high boundary wall
with at least two exit gates.
Building shall be plastered and painted with
uniform colour scheme.
a.
b.
There shall be no unwanted/outdated posters
pasted on the walls of building and boundary
of the hospital.
There shall be no outdated/unwanted
hoardings in hospital premises.
There shall be provision of adequate light in the
night so hospital is visible from approach road.
Proper landscaping and maintenance of trees,
gardens etc. should be ensured.
There shall be no encroachment in and around
the hospital.
ii) Signage
The building should have a prominent board
displaying the name of the Centre in the local
language at the gate and on the building.
Signage indicang access to various facilies at
strategic points in the Hospital for guidance of
the public should be provided. For showing the
direcons, colour coding may be used.
Cizen charter shall be displayed at OPD and
Entrance in local language including paent
rights and responsibilies.
Hospital lay out with locaon and name of the
facility shall be displayed at the entrance.
Direconal signages for Emergency, all the
Departments and ulies shall be displayed app-
ropriately, so that they can be accessed easily.
Florescent Fire Exit plan shall be displayed at
each oor.
Safety, Hazard and cauon signs displayed
prominently at relevant places.
Display of important contacts like higher
medical centres, blood banks, re department,
police, and ambulance services available in
nearby area.
Display of mandatory informaon (under RTI
Act, PNDT Act, MTP Act etc.).
iii) General Maintenance
Building should be well maintained with no seepage,
cracks in the walls, no broken windows and glass panes.
There should be no growth of algae and mosses on walls
etc. Hospital should have an-skid and non-slippery oors.
iv) Condion of roads, pathways and drains
Approach road to hospital emergency shall be
all weather motorable road.
Roads shall be illuminated in the nights.
c.
d.
e.
f.
g.
a.
b.
c.
d.
e.
f.
g.
h.
a.
b.
27
There shall be dedicated parking space
separately for ambulances, Hospital sta and
visitors.
There shall be no stagnaon/over ow of
drains.
There shall be no water logging/marsh in or
around the hospital premises.
There shall be no open sewage/ditches in the
hospital.
v) Environmental friendly features
The Hospital should be, as far as possible, environment
friendly and energy ecient. Rain-Water harvesng,
solar energy use and use of energy-ecient bulbs/
equipment should be encouraged. Provision should be
made for horculture services including herbal garden.
A room to store garden implements, seeds etc. will be
made available.
vi) Barrier free access
For easy access to non-ambulant (wheel-chair,
stretcher), semi-ambulant, visually disabled and
elderly persons infrastructure as per Guidelines and
Space Standards for barrier-free built environment for
Disabled and Elderly Persons of Government of India, is
to be provided. This will ensure safety and ulizaon of
space by disabled and elderly people fully and their full
integraon into the society. Provisions as per Persons
with Disability Act should be implemented.
vii) Administrave Block
Administrave block aached to main hospital along
with provision of MS Oce and other sta will be
provided. Block should have independent access and
connecvity to the main hospital building, wherever
feasible.
viii) Circulaon Areas
Circulaon areas comprise corridors, lis, ramps,
staircase and other common spaces etc. The ooring
should be an-skid and non-slippery.
Corr|dors Corridors shall be at least 3 m Wide to
accommodate the daily trac. Size of the corridors,
ramps, and stairs shall be conducive for manoeuvrability
of wheeled equipment. Corridors shall be wide enough
to accommodate two passing trolley, one of which may
have a drip aached to it. Ramps shall have a slope of
1:15 to 1:18. It must be checked for manoeuvrability of
beds and trolleys at any turning point.
c.
d.
e.
f.
ix) Roof Height
The roof height should not be less than approximately
3.6 m measured at any point from oor to roof.
x) Entrance Area
Barrier free access environment for easy access to non-
ambulant (wheel-chair, stretcher), semi-ambulant,
visually disabled and elderly persons as per Guidelines
and Space Standards for barrier-free built environment
for Disabled and Elderly Persons of CPWD/Min of
Social Welfare, GOI.
Ramp as per specicaon, Hand- railing, proper
lightning etc. must be provided in all health facilies
and retroed in older one which lacks the same.
The various types of trac shall be grouped for entry
into the hospital premises according to their nature.
An important consideraon is that trac moving at
extremely dierent paces (e.g. a paent on foot and an
ambulance) shall be separated. There can be four access
points to the site, in order to segregate the trac.
Lmergency: for paents in ambulances and
other vehicles for emergency department.
Serv|ce: for delivering supplies and collecng
waste.
Serv|ce: 5/0 0(;/-*: /5 2(*2
Ma|n: for all others
xi) Residenal Quarters
All the essenal medical and para-medical sta will
be provided with residenal accommodaon. If the
accommodaon can not be provided due to any reason,
then the sta may be paid house rent allowance, but in
that case they should be staying in near vicinity, so that
essenal sta is available 24 x 7.
Disaster Prevenon Measures
(For all new upcoming facilies in seismic zone 5
or other disaster prone areas)
@()30*R:(
Building structure and the internal structure of Hospital
should be made disaster proof especially earthquake
proof, ood proof and equipped with re protecon
measures.
Earthquake proof measures structural and non-
structural should be built in to withstand quake as per
1.
2.
3.
4.
28
geographical/state Govt. guidelines. Non-structural
features like fastening the shelves, almirahs, equipment
etc. are even more essenal than structural changes
in the buildings. Since it is likely to increase the cost
substanally, these measures may especially be taken
on priority in known earthquake prone areas. (For more
2(<*3:) 0(5(0 </ Annexure Ik.)
Fire ghng equipment re exnguishers, sand
buckets, etc. should be available and maintained to be
readily available when there is a problem.
Every district hospital shall have a dedicated
disaster management plan in line with state disaster
management plan. Disaster plan clearly denes the
authority and responsibility of all cadres of sta and
mechanism of mobilizaon resources.
All health sta should be trained and well conversant
with disaster prevenon and management aspects.
Regular mock drill should be conducted. Aer each drill
the ecacy of disaster plan, preparedness of hospital
and competence of sta shall be evaluated followed by
appropriate changes to make plan more robust.
Hospital communicaon
24x7 working telephone shall be available
for hospital. Addional telephone lines with
restricted access for priority messages should
be installed especially with ISD facilies. All
messages should be wrien down in the log
book in details for follow up especially in
case of disaster situaons. Wireless Services
with police assistance and hotline with the
collector can be used in emergency. Fax should
be used for communicaon of informaon like
quanty of drugs, specicaon of equipment
etc so as to avoid errors.
Internal communicaon system for
connecng important areas of hospitals like
Emergency, Wards, OT, Kitchen, Laundry, CSSD,
administraon etc. should be established.
Central Informaon booth should be funconal
and competent person shall be available for
answering the enquiries. The anxious excited
friends and relaves want to know the welfare
of their kith and kin and hospital authories
should calm them down, console them and
provide them with detail informaon from
me to me from informaon booth. List of
paents may be displayed with their bed/ward
locaon.
Crowds should be controlled and only the

authorized aendants/relaves with passes
should be allowed entry
Departmental Lay Out
!:3936*: &(0-36()
I) Outdoor Paent Department (OPD)
$he facility shall be planned keeping in mind the
maximum peak hour paent load and shall have the
scope for future expansion. OPD shall have approach
from main road with signage visible from a distance.
a. kecepnon and Lnqu|ry
Enquiry/May I Help desk shall be available with
competent sta uent in local language. The
service may be outsourced.
Services available at the hospital displayed at
the enquiry.
#*;( *92 6/9<*6<) /5 0()B/9)3R:( B(0)/9) :38(
Medical superintendent, Hospital Manager,
Causality Medical ocer, Public Informaon
Ocer etc. shall be displayed.
b. Wa|nng Spaces
Waing area with adequate seang arrangement shall be
provided. Main entrance, general waing and subsidiary
waing spaces are required adjacent to each consultaon
and treatment room in all the clinics. Waing area at the
scale of 1 sq /per average daily paent with minimum
400 sq of area is to be provided.
c. Layout of CD shall follow funconal ow of the
paents, e.g.:
EnquiryRegistraonWaingSub-waing
!:3936Dressing room/Injecon RoomBilling
Diagnoscs (lab/X-ray)Pharmacy%L3<
d. anent amen|nes (norms given in following pages)
Potable drinking water.
Funconal and clean toilets with running water
and ush.
Fans/Coolers.
Seang arrangement as per load of paent.
e. C||n|cs
The clinics should include general, medical, surgical,
ophthalmic, ENT, dental, obsetetric and gynaecology,
Post Partum Unit, paediatrics, dermatology and
venereology, psychiatry, neonatology, orthopaedic and

29
social service department. Doctor chamber should have
ample space to sit for 4-5 people. Chamber size of 12.0
sq meters is adequate. The clinics for infecous and
communicable diseases should be located in isolaon,
preferably, in remote corner, provided with independent
access. For Naonal Health Programme, adequate space
be made available. Immunizaon Clinic with waing
Room having an area of 3 m 4 m in PP centre/Maternity
centre/Pediatric Clinic should be provided. 1 Room for
HIV/STI counseling is to be provided. Pharmacy shall be
in close proximity of OPD. All clinics shall be provided
with examinaon table, X-ray- View box, Screens and
hand wishing facility. Adequate number of wheelchairs
and stretcher shall be provided.
f. Nurs|ng Serv|ces
Various clinics under Ambulatory Care Area require
nursing facilies in common which include dressing
room, side laboratory, injecon room, social service and
treatment rooms etc.
Nurs|ng Stanon: #((2 R*)(2 )B*6( 0(G?30(2 5/0 #?0)39+
Staon in OPD for dispensing nursing services. (Based
on OPD load of paent)
g" ua||ty Assurances |n C||n|cs
Work load at OPD shall be studied and
measures shall be taken to reduce the Waing
Time for registraon, consultaon, Diagnoscs
and pharmacy.
Punctuality of sta shall be ensured.
Cleanliness of OPD area shall be monitored on
regular basis.
There shall be provision of complaints/
suggeson box. There shall be a mechanism to
redress the complaints.
Hospital shall develop standard operang
procedures for OPD management, train the
sta and implement it accordingly.
Assessment of each paent shall be done in
standard format.
To avoid overcrowding hospital shall have
paent calling systems (manual/Digital).
h. Des|rab|e Serv|ces
Air-cooling
Paent calling system with electronic display
Specimen collecon centre
Television in waing area
1.
2.
3.
4.
Computerized Registraon
Public Telephone booth
40/-3)3/9 /5 "4@ ;*9*+(0
II) Imaging
The department shall be located at a place which is
accessible to both OPD and wards and also to operaon
theatre department. The size of the room shall
depend on the type and size of equipment installed. The
room shall have a sub-waing area with toilet facility and
a change room facility. Film developing and processing
(dark room) shall be provided in the department for
loading, unloading, developing and processing of X-
ray lms. Room shall be completely cut of from direct
light. Exhaust fan, venlators shall be provided. Room
shall have a loading bench (with acid and alkali resistant
top), processing tank, washing tank and a sink. Separate
Reporng Room for doctors shall be there.
Ultrasound room shall contain a paent couch, a chair
*92 *2(G?*<( )B*6(

for the equipment. The lighng must
be dim for proper examinaon. Hand-washing facility
and toilet shall be aached with ultrasound room.
rocess requ|rement and ua||ty Assurance |n kad|o|ogy
Lay out and construcon of X-Ray shall follow
the AERB guidelines.
T(*2 7B0/9) *92 1hermo Lum|nescent
Dos|meters (1LD) badges shall be available with
all the sta working in X-ray room. TLD badges
should be sent to BARC on regular bases for
assessment.
Cycle Time for reporng shall not be more than
24 hours. Same day reporng would be more
desirable.
Hospital shall ensure availability of adequate
number of X-ray lms at all the mes.
Fixer soluon used in lm processing shall not
be disposed in drains. It shall be auconed.
Mandatory informaon as per PNDT act shall be
displayed at ultrasonography centre. Records
shall also be maintained as per PNDT Act.
Service provided by the department with
schedule of charges shall be displayed at the
entrance of department.
Department shall develop standard operang
procedures for safe transportaon of the
paent to the department, handling and safe
5.
6.
7.
1.
2.
3.
4.
5.
6.
7.
8.
30
disposal of radioacve material and ecient
operaon of the department.
Department shall have a system of prevenve
maintenance, breakdown repairs and periodic
calibraon of equipment.
III) Clinical Laboratory
The department shall be situated such that it has easy
access to IPD as well as OPD paents. The Laboratory
shall have adequate space from the point of view
of workload as well as maintenance of high level of
hygiene to prevent the infecon. Storage space shall
be adequate (10% of total oor space) with separate
storage space for inammable items. The layout shall
ensure logical ow of specimens from receipt to
disposal. There shall be separate and demarcated areas
for sample collecon, sample processing, hematology,
biochemistry, clinical pathology and reporng. The
table top shall be acid and alkali proof.
Quality Assurance in Laboratory Services
External validaon of lab reports shall be done on regular
basis. Facility of emergency laboratory services shall
be available. Service provided by the department with
schedule of charges shall be displayed at the entrance
of department. Timely reporng should be ensured.
IV) Blood Bank
Blood bank shall be in close proximity to pathology
2(B*0<;(9< *92 *< *9 *66())3R:( 23)<*96( </
operaon theatre department, intensive care units
and emergency and accident department. Blood
Bank should follow all exisng guidelines and fulll
all requirements as per the various Acts pertaining
to seng up of the Blood Bank. Separate Reporng
Room for doctors should be there.
Quality Assurance in blood bank
Hospital should follow standard operang
B0/6(2?0( 5/0 ;*9*+(;(9< /5 R://2 R*98
services including policy on raonal use of blood
and blood product promulgated by Central/State
Government, selecon of donors, counselling and
examinaon of donors, consent for donaon, issue
and transport of blood, storage of blood, cross
matching, blood transfusion, safety precauon.
Blood bank shall validate the test results from
external labs on regular basis.
9.
1.
2.
Service provided by the department with
schedule of charges shall be displayed at the
entrance of department.
Availability of blood group shall be displayed
prominently in the blood bank.
Blood bank shall adhere to NACO guidelines
and drug and cosmec act strictly.
Blood bank shall pracce rst in rst out policy
for reducon of waste. Adequate measures
shall be taken to prevent expiry of blood or
blood components.
Use of blood component shall be encouraged.
V) Intermediate Care Area
(Indoor Paent Department)
General IPD beds shall be categorized as following
'*:( '(236*: 1*02
'*:( )?0+36*: 1*02
.(;*:( '(236*: 1*02
.(;*:( )?0+36*: 1*02
Maternity ward
4*(23*<036 1*02
Nursery
Isolaon ward
As per need and infrastructure hospital have following
1*02)
Emergency ward/trauma ward
Burn Ward
Orthopaedic ward
Post operave ward
Ophthalmology Ward
'*:*03* N*02
Infecous Disease Ward
r|vate ward: Depending upon the requirement
of the hospital and catchment area, appropriate
beds may be allowed for private facility. 10%
of the total bed strength is recommended as
private wards beds.
Locaon
Locaon of the ward should be such to ensure quietness
and to control number of visitors.
N*02 U93<
It is desirable that upto 20 % of the total beds may be
earmarked for the day care facilies, as many procedures
can be done on day care basis in modern mes.
3.
4.
5.
6.
7.
1.
2.
3.
4.
5.
6.
7.
8.
1.
2.
3.
4.
5.
6.
7.
8.
31
The basic aim in planning a ward unit should be to
minimize the work of the nursing sta and provide basic
amenies to the paents within the unit. The distances
to be traveled by a nurse from bed areas to treatment
room, pantry etc. should be kept to the minimum. Ward
unit will include nursing staon, doctors duty room,
pantry, isolaon room, treatment room, nursing store
along with wards and toilets as per the norms. On an
average one nursing staon per ward will be provided. It
should be ensured that nursing staon caters to around
40-45 beds, out of which half will be for acute paents
and half for chronic paents. The following quality
parameters should be ensured:
There shall be at least 2.5 metre between
centres of two beds to prevent cross infecon
and allow bedside nursing care.
Every bed shall be provided with IV stand, bed
side locker and stool for aendant. Screen shall
be available for privacy.
Dedicated toilets with running water facility
and ush shall be provide for each ward.
Dirty ulity room with sluicing facility and
janitors rooms shall be provided with in
ward.
All wards shall be provided with posive
venlaon (except isolaon ward) and fans.
VI) Pharmacy (Dispensary)
The pharmacy should be located in an area
conveniently accessible from all clinics. The size should
be adequate to contain 5 percent of the total clinical
visits to the OPD in one session. For every 200 OPD
paents daily there should be one dispensing counter.
Pharmacy should have component of medical store
facility for indoor paents and separate pharmacy with
accessibility for OPD paents.
Hospital shall have standard operang procedure
for stocking, prevenng stock out of essenal drugs,
receiving, inspecng, handing over, storage and
retrieval of drugs, checking quality of drugs, inventory
management (ABC & VED), storage of narcoc drugs,
checking pilferage, date of expiry, pest and rodent
control etc.
VII) Paent Conveniences
Number of to||ets etc. to be prov|ded as per number of
beds of nosp|ta|]CD |oad.
VIII) Dharamshala
It is a premises providing temporary accommodaon for
short duraon. The area shall be minimum 0.25 hectares
of land adjoining or within the Hospital premises.
IX) Intensive Care Unit and High Dependency
N*02)
>(9(0*:
In this unit, crically ill paents requiring highly
)83::(2 :35( )*-39+ ;(236*: *32 *92 9?0)39+ 6*0(
are concentrated. These should include major
surgical and medical cases, head injuries, severe
haemorrhage, acute coronary occlusion, kidney and
respiratory catastrophe, poisoning etc. It should be
the ulmate medicare the hospital can provide with
highly specialized sta and equipment. The number
of paents requiring intensive care may be about 5
to 10 percent of total medical and surgical paents
in a hospital. The unit shall not have less than 4 beds
nor more than 12 beds. Number of beds may be
restricted to 5% of the total bed strength inially but
should be expanded to 10% gradually. Out of these,
they can be equally divided among ICU and High
Dependency Wards. For example, in a 500-bedded
hospital, total of 25 beds will be for Crical Care. Out
of these, 13 may be ICU beds and 12 will be allocated
for High Dependency Wards. Changing room should
be provided for.
Locaon
This unit should be located close to operation theatre
department and other essential departments, such as,
X-ray and pathology so that the staff and ancillaries
could be shared. Easy and convenient access
from emergency and accident department is also
essential. This unit will also need all the specialized
services, such as, piped suction and medical gases,
uninterrupted electric supply, heating, ventilation,
central air conditioning and efficient life services. A
good natural light and pleasant environment would
also be of great help to the patients and staff as
well.
Facilies
Nurses Staon
Clean Ulity Area
%G?3B;(9< F//;
32
X) Accident and Emergency Services
24 x 7 operaonal emergency with dedicated
emergency room shall be available with
adequate man power.
It should preferably have a disnct entry
independent of OPD main entry so that a
very minimum me is lost in giving immediate
treatment to casualies arriving in the
hospital. There should be an easy ambulance
approach with adequate space for free passage
of vehicles and covered area for alighng
paents.
Lay out shall follow the funconal ow.
Signage of emergency shall be displayed at the
entry of the hospital with direconal signage at
key points.
Emergency shall have dedicated triage,
resuscitaon and observaon area. Screens
shall be available for privacy.
Separate provision for examinaon of rape/
sexual assault vicm should be made available
in the emergency as per guidelines of the
Supreme Court.
Emergency should have mobile X-ray/
laboratory, side labs/plaster room/and minor
1.
2.
3.
4.
5.
6.
7.
OT facilies. Separate emergency beds may
be provided. Duty rooms for Doctors/nurses/
paramedical sta and medico legal cases.
Sucient separate waing areas and public
amenies for paents and relaves and
located in such a way which does not disturb
funconing of emergency services.
Emergency block to have ECG, Pulse
Oxymeter, Cardiac Monitor with Debrillator,
Mulparameter Monitor, Venlator also.
Stretcher, wheelchair and trolley shall be
available at the entrance of the emergency at
designated area.
XI) Operaon Theatre
Operaon theatre usually have a team of surgeons
anesthests, nurses and someme pathologist and
radiologist operate upon or care for the paents. The
locaon of Operaon theatre should be in a quite
environment, free from noise and other disturbances,
free from contaminaon and possible cross infecon,
maximum protecon from solar radiaon and
convenient relaonship with surgical ward, intensive
care unit, radiology, pathology, blood bank and CSSD.
This unit also needs constant specialized services, such
as piped sucon and medical gases, electric supply,
8.
9.
S|.
No.
I|tments nosp|ta| for |ndoor
panents wards Ior
ma|e & fema|e
nosp|ta| w|th outdoor panent Adm|n|stranve bu||d|ng
Ma|e Iema|e Ma|e Iema|e
= N*<(0 6:/)(< One for every 6 beds One for every
=KK B(0)/9)
$1/ B(0 =KK
B(0)/9)
One for every 25
B(0)/9)
One for every 15
B(0)/9)
2 Wash basins Two for upto 24 per-
sons, add one for ev-
ery addional 24 beds
One for every
=KK B(0)/9)
One for every
=KK B(0)/9)
One for every 25
B(0)/9)
One for every 25
B(0)/9)
C Baths with
shower
One bath with shower
for every 6 beds
- - One on each
oor
One on each
oor
D Bed pan
washing sinks
One for each six beds
1*02
- - - -
E !:(*9(0) )398 One for each ward One per oor
;393;?;
One per oor
;393;?;
One per oor
;393;?;
One per oor
;393;?;
H Kitchen sinks and
dish washers
"9( B(0 1*02 - - - -
J U039*:) One per 20 persons. "9( B(0 EK
B(0)/9)
- One/20 persons, add one per
addional 20 persons. From 101 to
200 persons add @ 3% and over 200
persons add 2.5%
#/0;) 5/0 .3<;(9<)
33
heang, air-condioning, venlaon and ecient li
service, if the theatres are located on upper oors.
Zoning should be done to keep the theatres free from
micro organisms. There may be four well dened
zones of varying degree of cleanliness/asepsis namely,
Protecve Zone, Clean Zone, Aspecc or Sterile
Zone and Disposal or Dirty Zone. Normally there are
three types of trac ow, namely, paents, sta and
supplies. All these should be properly channelized.
An Operaon Theatre should also have Preparaon
Room, Pre-operave Room and Post Operave
Resng Room. Operang room should be made dust-
proof and moisture proof. There should also be a
Scrub-up room where operang team washes and
scrub-up their hands and arms, put on their sterile
gown, gloves and other covers before entering the
operaon theatre. The theatre should have sink/
photo sensors for water facility. Laminar ow of air
be maintained in operaon theatre. It should have a
single leaf door with self closing device and viewing
window to communicate with the operaon theatre.
A pair of surgeons sinks and elbow or knee operated
taps are essenal. Operaon Theatre should also
have a Sub-Sterilizing unit aached to the operaon
theatre liming its role to operang instruments on
an emergency basis only.
Theatre refuse, such as, dirty linen, used instruments
and other disposable/non disposable items should be
removed to a room aer each operaon. Non-disposable
instruments aer inial wash are given back to instrument
sterilizaon and rest of the disposable items are disposed
o and destroyed. Dirty linen is sent to laundry through
a separate exit. The room should be provided with sink,
slop sink, work bench and draining boards.
XII) Delivery Suite Unit
The delivery suit unit be located near to operaon
theatre & located preferably on the ground oor.
The delivery Suit Unit should include the facilies of
accommodaon for various facilies as given below:
Recepon and admission
Examinaon and Preparaon Room
Labour Room (clean and a sepc room)
Delivery Room
Neo-natal Room
Flow Chart of Emergency Department
IDLN1IIICA1ICN 1kIAGL
M;;(23*<( U0+(9< Non-urgent @(*2
Mortuary
Non-urgent
$0(*<;(9< 70(*
Resuscitaon
U0+(9<
$0(*<;(9< 70(*
F(6(3-39+ N*02 M!U
In paent Evacuaon or holding area
1ransfer Cut
E
M
E
R
G
E
N
C
Y
M9
"$
>(9(0*: N*02
A
"
&
4
M
$
7
T
"?<
7;R?:*96(
34
Sterilizing Rooms
&<(03:( &</0( F//;
&60?RR39+ F//;
Dirty Ulity
Doctors Duty Room
Nursing Staon
Nurses changing Room
Group C & D Room
%6:*;B)3* F//;
XIII) Post Partum Unit
It is desirable that every District Hospital should
have a Post Partum Unit with dedicated sta and
infrastructure to provide Post natal services, all
Family Planning Services, Safe Aboron services and
immunizaon in an integrated manner. The focus will
be to promote Post Partum Sterilizaon and will be
provided if the case load of the deliveries is more than
75 per month.
XIV) Physical Medicine and Rehabilitaon (PMR)
The PMR department provides treatment facilies
to paents suering from crippling diseases and
disabilies. The department is more frequently visited
by out-paents but should be located at a place which
may be at convenient access to both outdoor and indoor
paents with privacy. It should also have a physical
and electro-therapy rooms, gymnasium, oce, store
and toilets separate for male and female. Normave
standards will be followed.
Hospital Administrave and Support Services
I) Management Informaon System (MIS)
Computer with Internet connecon is to be provided
for MIS purpose. Provision of ow of Informaon
from PHC/CHC to district hospital and from there
to district and state health organizaon should be
established. Relevant informaon with regards to
emergency, outdoor and indoor paents be recorded
and maintained for a sucient duraon of me as per
state health policy.
M9B?<

MRD, Emergency, ICU, Labs, Dietary, Laundry, CSSD etc.
40/6())

Hospital Informaon System
4?R:36
Channel
!:3936*:
Channel
Sta
Channel
Administrave
Channel
"?<B?<
II) Hospital Kitchen (Dietary Service)
The dietary service of a hospital is an important
therapeuc tool. It should easily be accessible from
outside along with vehicular accessibility and separate
room for diecian and special diet. It should be located
such that the noise and cooking odours emanang
from the department do not cause any inconvenience
to the other departments. At the same me locaon
should involve the shortest possible me in delivering
food to the wards. Apart from normal diet diabec,
semi solid diets and liquid diet shall be available .//2
shall be distributed in covered container. Quality and
quanty of diet shall be checked by competent person
on regular basis.
III) Central Sterile Supply Department (CSSD)
As the operaon theatre department is the major
consumer of this service, it is recommended to locate
the department at a posion of easy access to operaon
theatre department. It should have a provision of hot
water supply. Department shall develop and implement
the Standard Operang Procedures (SOPs) for transfer
/5 ?9)<(03:( *92 )<(03:( 3<(;) R(<1((9 !&&@ *92
departments, sterilizaon of dierent items, complete
process cycle, validaon of sterilizaon process, recall,
labelling, rst in rst out, calibraon and maintenance
of instruments.
IV) Hospital Laundry
It should be provided with necessary facilies for
drying, pressing and storage of soiled and cleaned
linens. It may be outsourced.
V) Medical and General Stores
Medical and general stores should have vehicular
accessibility and venlaon, security and re ghng
arrangements. Hospital shall have standard operang
procedure for local purchase, indent management,
storage preparaon of monthly requirement plan and
Inventory analysis.
Ior Storage of Vacc|nes and other |og|sncs
Cold Chain Room: 3.5 m 3 m in size
Vaccine & Logiscs Room: 3.5 m 3 m in size
Minimum and maximum Stock shall be 0.5 and 1.25
month respecvely. Indent order and receipt of vaccines
and logiscs should be monthly. Timely receipt of
required vaccines and Logiscs from the District Stores,
should be ensured.
35
VI) Mortuary
It provides facilies for keeping of dead bodies and
conducng autopsy. The Mortuary shall be located in
separate building near the Pathology on the Ground Floor,
easily accessible from the wards, Accident and emergency
Department and Operaon Theatre. It shall be located
away from general trac routes used by public.
Post-mortem room shall have stainless steel autopsy
table with sink, a sink with running water for specimen
washing and cleaning and cup-board for keeping
instruments. Proper illuminaon and air condioning
shall be provided in the post mortem room.
A separate room for body storage shall be provided
with at least 2 deep freezers for preserving the body.
There shall be a waing area for relaves and a space
for religious rites.
VII) Engineering Services
L|ectr|c Lng|neer|ng Sub Stanon and Generanon
Electrical load requirement per bed = 3 KW to 5 KW.
Electric sub staon and standby generator room should
be provided.
I||um|nanon
The illuminaon and lightning in the hospital should be
done as per the prescribed standards.
Lmergency L|ghnng
Shadow less light in operaon theatre and delivery rooms
should be provided. Emergency portable light units
should be provided in the wards and departments.
Ca|| 8e||s
Call bells with switches for all beds should be provided
in all types of wards with indicator lights and locaon
indicator situated in the nurses duty room of the wards.
Venn|anon
The venlaon in the hospital may be achieved by either
natural supply or by mechanical exhaust of air.
Mechan|ca| Lng|neer|ng
Air-condioning and Room Heang in operaon theatre
and neo-natal units should be provided. Air coolers or
hot air convectors may be provided for the comfort of
paents and sta depending on the local needs.
Hospital should be provided with water coolers and
0(503+(0*</0 39 1*02) *92 2(B*0<;(9<) 2(B(9239+ ?B/9
the local needs.
Public Health Engineering
Water Supp|y
Arrangement should be made for round the clock piped
water supply along with an overhead water storage tank
with pumping and boosng arrangements.
Water requirement per bed per day = 450 to 500 litres
(Excluding requirements for AC, Fire-ghng,
Horculture and steam).
Dra|nage and San|tanon
The construcon and maintenance of drainage and
sanitaon 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.
S|. No. Department I||um|nanon (|ux)
= Recepon and waing room =EK
2 N*02)
2a >(9(0*: =KK
2b Beds =EK
C Operaon Theatre
C* >(9(0*: CKK
CR $*R:() Special Lighng
D T*R/0*</03() CKK
E Radiology =KK
H Casualty and Outpaent Departments =EK
J &<*30) *92 6/0032/0 =KK
I @3)B(9)*03() CKK
BIS standards for illuminaon are
36
Other Amenies
Disabled friendly, WC with basins wash basins
as specied by Guidelines for disabled friendly
environment should be provided.
VIII) Waste Disposal System
Naonal Guidelines on Bio-Medical Waste Management
*0( *< Annexure II A.
Mercury waste management guidelines are placed at
Annexure II 8.
IX) Housekeeping services
Hospital shall develop and implement standard operang
procedure for cleaning techniques, pest control,
frequency and supervision of housekeeping acvies.
X) Medical Gas
All gases may preferably be supplied through manifold
system.
XI) Cooking Gas
Liqueed petroleum gas (LPG) will be used for
cooking.
XII) Building Maintenance
Provision for building maintenance sta and an oce-
cum store will be provided to handle day to day
maintenance work.
XIII) Annual Maintenance Contract (AMC)
AMC should be taken for all equipment which need
special care and prevenve maintenance done to avoid
break down and reduce down me of all essenal and
other equipment.
XIV) Record Maintenance
(Medical Record Department)
Hospital shall have dedicated medical record
department to store paents record and other data
pertaining to hospital.
XV) Commiee Room
A meeng or a commiee room for conferences,
trainings with associated furniture.
XVI) Hospital Transport Services
Hospital shall have well equipped Basic Life
support (BLS) and desirably one Advanced Life
Support (ALS) ambulance.
Ambulances shall be provided with
communicaon system.
There shall be separate space near emergency
for parking of ambulances.
Serviceability and availability of equipment and
drugs in ambulance shall be checked on daily
basis.
'*9B/1(0 F(G?30(;(9<)
Following is the m|n|mum essenna| ;*9B/1(0
required for a funconal District Hospital of dierent
bed strengths as indicated. Eorts shall be made by the
&<*<()VU$) </ B0/-32( *:: 2()30*R:( )(0-36() 396:?239+
super-specialty services as listed, as and when the
required manpower is available in the concerned
District/State.
1.
2.
3.
4.
Spec|a|ty 100 8eds 200 8eds 300 8eds 400 8eds S00 8eds
'(23639( 2 2 C D E
Surgery 2 2 C C D
Obstetric & Gynae 2 3 4 E H
4*(23*<036) 2 C D D E
Anaesthesia 2 2 C C D
Opthalmology = = 2 2 2
Orthopaedics = = 2 2 2
Radiology = = 2 2 2
Pathology = 2 C C D
%#$ = = 2 2 2
@(9<*: = = 2 C C
'" == =C =E =O 23
Dermatology =Y =Y = = =
Psychiatry = = = = =
Microbiology =Y =Y = = =
./0(9)36 &B(63*:3)< =Y =Y = = =
AYUSH Doctors
Z
= = = 2 2
1ota| 29+3 34+3 S0 S8 68
Y@()30*R:(
Z
If more than one AYUSH doctors are available, at least one doctor should have a recognised PG qualicaon in relevant system under AYUSH.
District Hospital Man PowerMedical
37
Cadre 100 8eds 200 8eds 300 8eds 400 8eds S00 8eds
Sta Nurse 4S 90 13S 180 22S
Lab Tech H O 12 =E =I
Pharmacist 4+1
Z
6+1
Z
8+1
Z
10+1
Z
12+1
Z
&</0(8((B(0 = = 2 2 2
Radiographer 2 C E J O
ECG Tech/Eco = 2 C D E
7?23/;(<0363*9 - - = = =
Optha. Ass. = = 2 2 2
EEG Tech - - = = =
Diecian = = = = =
Physiotherapist = = 2 2 C
O.T. technician D H I 12 =D
CSSD Ass. = = 2 2 C
&/63*: N/08(0 2 C D E H
!/?9)(::/0 = = 2 2 2
Dermatology Technician - - = = =
Cyto-Technician - - = = =
PFT Technician - - - - 2
Dental Technician = = 2 2 C
Darkroom Ass. 2 C E J O
Rehabilitaon Therapist = = 2 2 C
Biomedical Engineer* = = = = =
1ota| 76 132 201 261 32S
Z
For AYUSH
Y@()30*R:(
District Hospital Man Power Nurses and Para-Medical
@/6</0) 29 CD EK EI HI
Sta Nurse DE OK =CE =IK 225
4*0*;(236*:) C= 42 HH I= =KK
1ota| Strength 10S 166 2S1 319 393
$/<*: '(236*: *92 4*0*;(236*: '*9B/1(0
A/)B3<*: 72;393)<0*</0 = = = 2 2
A/?)(8((B(0V;*9*+(0 = 2 C D E
Medical Records ocer = = = = =
Medical Record Ass. = 2 C C C
766/?9<)V.39*96( 2 C D E H
Admn. Ocer = = = = =
Oce Ass. Gr I = = 2 2 2
Oce Ass. Gr II = = 2 C D
Ambulance Services (1 driver + 2 Tech.) = = 2 C C
1ota| 12 1S 21 26 29
Note: Manpower for the serv|ces wh|ch are outsourced are not shown here |.e services like Mali, Dhobi, Waste handler, Aya, Peon, OPD Aendant, Ward
Boys, Parking aendant, Plumber, Electrician, Mistry, Vehicle drivers, Security and Sanitary workers etc.
District Hospital Man Power Administraon
38
District Public Health Unit
This unit may be located in the District Hospital. The Unit
shall be responsible for carrying out and coordinang
the acvies required for prevenng and controlling
public health emergency situaon like epidemic,
disaster an event aecng the community at large. The
acvies shall include Integrated Disease surveillance,
epidemic invesgaons, establishing community and
Laboratory diagnosis, implemenng public health
measures required in epidemic and disaster situaons
and emergency response
"9( %B32(;3/:/+3)<
"9( %9</;/:/+3)<
"9( '360/R3/:/+3)<
One IEC Ocer
One District Public Health Nursing Ocer
One District Data analyst/Demographer
Man Power Blood Bank
S|.
No.
Cadre 100
8eds
200
8eds
300
8eds
400
8eds
S00
8eds
=
Blood Bank In-
charge (Doctor
Pathologist)
- - = = =
2 Sta Nurse C C C C C
C
'*:(V.(;*:(
Nursing Aendant
= = = = =
D
Blood Bank
Technician
= = = 2 2
E &1((B(0 = = = = =
Post Partum Unit (Desirable)*
S. No. Cadre Number
= Doctor: MBBS with PG in Obstetrics
and Gynecology:
=
2 Sta Nurse =
C Counselor cum Data entry Operator
=
*In case the delivery case load is more than 75 per month
Note: General HR and Bed norms for Obstetric Cases
No. of
De||ver|es |n
a month
kequ|rement
of 8ed
kequ|rement
of Labour
tab|e
nk requ|re-
ment Sta
Nurses
=KK
2(:3-(03()
=K R(2) 2 Labour
<*R:()
D 5/0 T*R/?0
F//;)
E 5/0 7#!V
4#! N*02)
Specic requirements for nursing sta can be calculated
according to Indian Nursing Council Norms, as given below
1.
2.
3.
4.
5.
6.
= 9?0)( 5/0 H R(2) 5/0 >(9(0*: N*02
= #?0)( 5/0 D R(2) &B(63*: 1*02
= #?0)( 5/0 = R(2 5/0 M!U
2 Nurse for one OT Table
2 Nurse for one Labour room
One Nurse for a load of 100 paent Injecons
DEW :(*-( 0()(0-(
%G?3B;(9< #/0;)
%G?3B;(9< 9/0;) *0( 1/08(2 /?< 8((B39+ 39 ;392
the assured service recommended for various grades
of the district hospitals. The equipment required are
worked out under the following headings. Some of the
equipment which may be available in ideal situaon
have been indicated as Des|rab|e *92 0()< 3) Lssenna|.
M;*+39+ (G?3B;(9<
X-Ray Room Accessories
Cardiopulmonary Equipment
Labour ward, Neo Natal and Special Newborn
Care Unit (SNCU) Equipment
Immunizaon Equipment
Ear Nose Throat Equipment
Eye Equipment
@(9<*: %G?3B;(9<
Operaon Theatre Equipment
Laboratory Equipment
&?0+36*: %G?3B;(9< &(<)
Physical Medicine and Rehabilitaon (PMR)
%G?3B;(9<
Endoscopy Equipment
Anaesthesia Equipment
Furniture & Hospital Accessories
4/)< '/0<(; (G?3B;(9<
T39(9
Teaching Equipment
Administraon
Refrigeraon & AC
A/)B3<*: 4:*9<)
Hospital Fings & Necessies
$0*9)B/0<
Radiotherapy
Intensive Care Unit (ICU)
The detailed informaon on service norms for equipment
for 100-200 bedded, 201-300 bedded and 301 to 500
beds district Hospitals is given in the Table I to XXIII.
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
XVI.
XVII.
XVIII.
XIX.
XX.
XXI.
XXII.
XXIII.
XXIV.
XXV.
39
S|. No. Name of the Lqu|pment 101-200 8edded 201-300 8edded (301-S00 8edded)
= 500 M.A. X-ray machine* = @()30*R:( = =
2 300 M.A. X-ray machine = = =
C 100 M.A. X-ray machine = = =
D 60 M.A. X-ray machine (Mobile) = @()30*R:( = =
E C arm with accessories* = @()30*R:( 1 (Desirable) 1 (Desirable)
H Dental X-ray machine = = =
J Color Doppler Ultrasound machine with 4 probes:
Abdomen, Paediatric, So Parts and Intra-cavitory
Ultra Sonogram (Obs & Gyne. department should be
having a separate ultra-sound machine of its own)
1 + 1 2 + 1 3 + 1
I 4/0<*R:( ?:<0*)/?92 - 1 (Desirable) 1 (Desirable)
O C.T. Scan Mul slice (64 slice) = @()30*R:( 1 (Desirable) 1 (Desirable)
=K Mammography Unit* = @()30*R:( 1 (Desirable) =
== Echocardiogram* = @()30*R:( 1 (Desirable) 1 (Desirable)
12 MRI 1.5 Tesla 1 (Desirable)
Note: X-ray machines should preferably be Digital.
* To be provided as per need.
I. Imaging Equipment
S|. No. Name of the Lqu|pment 101-200 8edded 201-300 8edded 301-S00 8edded
= X-ray developing tank = 2 C
2 Safe light X-ray dark room 2 C D
C Cassees X-ray 12 =E 20
D X-ray lobby single H I =K
E X-ray lobby Mulple = = =
H T(*2 7B0/9 2 C C
J Intensifying screen X-ray = C C
I @/))3;(<(0 7) B(0 #((2
II. X-Ray Room Accessories
= ECG machine computerized = = =
2 ECG machine ordinary = 2 2
C 12 Channel stress ECG test equipment Tread Mill* @()30*R:( = =
D Echocardiography Machine 1 (Desirable) 1 (Desirable) =
E !*023*6 '/93</0 4 (+2 Desirable) I =K
H Cardiac Monitor with debrillator 2 2 2
J Venlators (Adult) 2 D E
I Venlators (Paediatrics) = = 2
O 4?:)( "L3;(<(0 C I I
=K Pulse Oximeter with NIB.P* = = =
== M95?)3/9 B?;B 2 2 2
12 B.P.apparatus table model =E 25 25
=C B.P.apparatus stand model =E 25 25
=D Stethoscope 20 DK DK
=E #(R?:3)(0 = 2 2
=H Peak Expiratory Flow Rate (PEFR) Meter (Desirable) = 2 2
III. Cardiopulmonary Equipment
40
= Baby Incubators = 3 (1 for labour room & 2
for neonatal room)
2
2 Phototherapy Unit 2 C D
C Emergency Resuscitaon Kit-Baby 2 D D
D Standard weighing scale 1 each for the labor
room & OT
1 each for the labor
room & OT
room & OT
E #(1R/09 !*0( %G?3B;(9< 1 set each for labor
room & OT
1 set each for labor
room & OT
1 set each for labor
room & OT
H Doubleoutlet Oxygen
!/96(9<0*</0
room & OT
room & OT
room & OT
J F*23*9< N*0;(0 2 3 (1 for labour room & 2
for neonatal room)
E
I F//; N*0;(0 2 2 2
O ./(<*: @/BB:(0 2 2 2
=K Cardio Toco Graphy Monitor 2 C 3 (Desirable)
== Delivery Kit =K =E 20
12 Episiotomy kit 2 =K =K
=C Forceps Delivery Kit 2 2 C
=D Crainotomy = 2 =
=E P*6??; (L<0*6</0 ;(<*: 2 2 2
=H Silasc vacuum extractor 2 2 C
=J Pulse Oxymeter baby & adult 1 each 2 each 2 each
=I Cardiac monitor baby & adult = 2 2 each
=O Nebulizer baby 2 4 (for ICU & wards) 2
20 Weighing machine adult C H D
21 Weighing machine infant C D D
22 CPAP Machine - - =
23 Head box for oxygen D H I
24 A*(;/+:/R39/;(<(0 = = 2
25 >:?6/;(<(0 = = 2
26 Public Address System = = =
27 N*:: !:/68 = = 2
28 BP Apparatus & Stethoscope 2+2 3+3 4+4
Equipment for Eclampsia Room (for 300-500 Bedded Hospital)
S|. No. Lqu|pment No.
= ICU Beds 2
2 Emergency Resuscitaon Tray (Adult) including intubaon equipment C
C BP Apparatus C
D !*023*6 '/93</0 2
E 4?:)( "L3;(<(0 2
H Airway (Female) 2
J #(R?:3)(0 =
IV. Labour ward, Neo Natal and Special Newborn Care Unit (SNCU) Equipment
41
S|. No. Lqu|pment No.
I Oxygen Supply (Central) 2
O Sucon Apparatus (Electrical) 2
=K Sucon Apparatus (Foot) =
== N*:: !:/68 =
12 Torch =
=C Emergency Call Bell 2
=D Stethoscope 2
A. General Equipment for SNCU
Electronic weighing scale 5 (essenal)
M95*9</;(<(0 5 (essenal)
Emergency drugs trolley 5 (essenal)
Procedure trolley 5 (essenal)
Wall clock with seconds hand 1 for each room
F(503+(0*</0 1 for the unit
&B/< :*;B 5 (essenal)
Portable x-ray machine 1 for the unit (essenal)
Basic surgical instruments e.g. ne scissors, scalpel with blades, ne artery forceps,
suture material & needles, towel, clips etc.
1 set per bed (essenal)
Nebulizer 1 for the unit
Mul-channel monitor with non-invasive BP monitor (3 size: 0, 1,
2-disposable in plenty-reusable neonatal probe, at least 4)
4 (desirable)
Room Thermometer 4 (essenal)
Equipment List for Special Newborn Care Unit (SNCU)
B. Equipment for disinfecon of Special Newborn Care Unit
Item kequ|rement for the un|t
Electric heater/boiler 2 (essenal)
Washing machine with dryer (separate) 1 (essenal)
%:(6<0/936 5?;3+*</0 2 (essenal)
P*6??; !:(*9(0 1 (essenal)
Gowns for doctors, nurses, neonatal aides, Group D sta & mothers Adequate number of each size (essenal)
Washable slippers Adequate number of each size (essenal)
Vercal Autoclave 1 (essenal)
Autoclave drums (large & medium & small sizes) At least 6 of each size (essenal)
Disinfectant Sprayer 1 (essenal)
!/9<*39(0 5/0 :3G?32 23)395(6<*9< 2 (essenal)
Formalin Vaporizer 1 (essenal)
A/< 730 "-(9 1 (desirable)
Ethylene oxide (ETO) Sterilizer 1 (desirable)
42
Item kequ|rement for the un|t
Servo-controlled Radiant Warmer 1 for each bed (essenal) + 2
Low-Reading Digital Thermometer (cengrade scale) 1 for each bed (essenal)
Neonatal Stethoscope 1 for each bed (essenal) + 2
Neonatal Resuscitaon Kit
(Laerdal type, Silicone, Autoclavable 240 ml, 450 ml
resuscitaon bag with valves- including pressure release
valve), oxygen reservoir & silicone round cushion masks
sizes 0 & 00),
Neonatal laryngoscope with straight blade and spare
bulbs)
1 set for each bed (essenal) + 2
Sucon Machine 1 for each beds (essenal)
(80% should be electrically operated & 20% foot operated)
Oxygen Hood (unbreakable-neonatal/infant size) 1 for each bed (essenal)
20% extra (in case of repair/disinfecon)
Non stretchable measuring tape (mm scale) 1 for each bed (essenal)
Infusion pump or syringe pump 1 for every 2 beds (essenal)
Pulse Oxymeter 1 for every 2 beds (essenal)
Double Outlet Oxygen Concentrator 1 for every 3 beds (essenal)
Double Sided Blue Light Phototherapy 1 for every 3 beds
CENTRAL AC 8 AIR EXCHANGE PER HOUR For the SNCU, Step-down Unit & SCBU
Generator (15 KVA) =
.:?L ;(<(0 1 (Desirable)
CFL Phototherapy 1 for every 3 beds (essenal)
Horizontal Laminar Flow 1 (essenal)
Window AC (1.5)/Split AC Laboratory & Teaching & Training room (essenal)
Doctors room (desirable)
C. Equipment for individual paent care in the Special Newborn Care Unit
@. Disposables
These items should be regularly supplied to the SNCU, if
necessary by changing policy:
!/02 6:*;B
Dee Lees Mucus Trap
Neoon (intravenous catheter) 24G
Micro drip set with & without buree
Blood Transfusion Set
3 way stop cock
Sucon Catheter size # 10, 12 Fr
Endotracheal Tube size # 2.5, 3, 3.5 mm
1.
2.
3.
4.
5.
6.
7.
8.
Feeding Tube size # 5, 6, 7 Fr
Syringes: Tuberculin- 1, 2, 5, 10, 50 cc with
needle nos. 22, 24, 26
Sterile gloves & drapes
Chemical disinfectants: Cidex, Bacillocid, Liquid
soap & detergent, Sterilium, Savlon, Phenol,
Lysol, Betadine and Reced Spirit
Glucosx and mulsx strips (in container)
Capillary Tubes for microhaematocrit (in
containers)
Coon, surgical gauze
Normal saline, 10% Dextrose infusion bole
9.
10.
11.
12.
13.
14.
15.
16.
43
ILR & DF with Stabilizer ILR 2, & DF 2 for purpose of roune immunizaon and in
T*R/?0 0//; Y
&B*0( 36( B*68 R/L one from each equipment
Room Heater/Cooler for immunizaon clinic with electrical
ngs
7) B(0 9((2
Waste disposal twin bucket, hypochlorite soluon/bleach 2 per ILR bimonthly
Freeze Tag Need Based
Thermometers Alcohol (stem) 2
Almirah for Vaccine logiscs 2
Almirah for vaccine logiscs =
Immunizaon table E
Chair for new sta proposed C
Stools for immunizaon room 2
Bench for waing area =
Dustbin with lid one from each equipment
N*<(0 6/9<*39(0 =
Hub cuers 2
5 KVA Generator with POL for immunizaon purpose 1 (If hospital has other Generator for general purpose this
is not needed.)
* The district hospitals have high delivery loads. Aer delivery newborns are to be given zero dose immunizaon. Hence a separate ILR and Deep freezer may
be provided near Labour room. Other ILR and Deep freezer may be provided for regular immunizaon.
V. Immunizaon Equipment
Ior Mon|tor|ng and Lecnve programme management for |mmun|zanon fo||ow|ng are to be used
= 7?23/;(<(0 = = 2
2 M;B(2*96( 7?23/;(<(0 = =
C Operang Microscope (ENT) 2 = 2
D Head light (ordinary) (Boyle Davis) = 2 C
F(+3)<(0) Immunizaon register
Vaccine stock & issue register
AD syringes, Reconstuon syringes, other logisc stock & issue register
Equipment, furniture & other accessories register
>(9()(< T/+R//8
'/93</039+ $//:) Tracking Bag and Tickler Box
Tally sheets
Immunizaon cards
$(;B(0*<?0( T/+R//8
'360/B:*9)
F(B/0<) Monthly UIP reports
Weekly surveillance reports (AFP, Measles)
&(03/?) 7%.M 0(B/0<)
"?<R0(*8 0(B/0<)
VI. Ear Nose Throat Equipment
44
E ENT Operaon set including headlight, Tonsils = = 2
H Ear Surgery Instruments set = 2 2
J '*)</32 &(< = = 2
I Micro Ear Set myringoplasty = = 2
O Stapedotomy Set = 2 =
=K Micro drill System set = 2
== ENT Nasal Set (SMR, Septoplasty, Nasa| Lndoscop|c
Set (o & 30) Polypetcomy, DNS, Rhinoplasty)
= = 2
12 Laryngoscope breopc ENT 2 = =
=C Laryngoscope direct = 2
=D "</)6/B( = 2 D
=E Oesophagoscope Adult
(Desirable)
= 2 =
=H Oesophagoscope Child
(Desirable)
= = =
=J Head Light (cold light) = = 2
=I Tracheostomy Set = = 2
=O $?939+ 5/08 = 2 D
20 Bronchoscope Adult & Child 1 (Desirable) 1 (Desirable) 1 (Desirable)
21 Examinaon instruments set (speculums, tongue
dipressors, mirrors, Bulls lamp)
= 2 D
22 Oto Acousc Emission (OAE) Analyzer 1 (Desirable) 1 (Desirable) 1 (Desirable)
23 &/?92 40//5 0//; 1 (Desirable) 1 (Desirable) 1 (Desirable)
VII. Eye Equipment
= Cryo Surgery Unit with rena probe = = 2
2 Opthalmoscope Direct + indirect 1 + 1 1 + 1 2 + 1
C &:3< T*;B = = 2
D Reno scope = = 2
E 4(03;(<(0 = = 2
H Binomags = = 2
J Distant Vision Charts = = 2
I Near Vision Chart = = 2
O Colour Vision Chart = = 2
=K Foreign Body spud and needle = = 2
== T*603;*: 6*99?:* *92 B0/R() = = 2
12 Lid retractors (Desmarres) = = 2
=C 4?96<?; @3:*</0 = = 2
=D Rotang Visual acuity drum = = 2
=E Torch = = 2
=H Trial Frame Adult/Children = = 2
45
VIII. Dental Equipment
1. Denta| Un|t comp|ete w|th fo||ow|ng fac|||nes
Dental Chair motorized with panel and foot
controlled with up and down movement.
730 F/</0
Compressor oil free medical grade (noise-free)
Ultrasonic Scalar with four ps.
Sucon ed in the dental chair medium and
high vacuum.
Air rotor hand piece contra angle two and one
straight hand piece (4 lakhs RPM).
LED light cure unit.
Latest foot operated light of 20,000 and
25,000/- Lux.
Air motor terminal with hand piece.
Dental X-ray IOP/OPG X-ray viewer with LED light.
Doctors Stool.
Medical Emergency tray.
2. Denta| Instruments
All types of dental extracon forceps (each set
3 sets- minimum required which includes upper
and lower molars and anterior forceps.
Elevators (Dental) all types (3 sets each).
7B(L/
Bonele
Bone cuer forceps one.
Chisel and hammer-one each.
Periosteal elevator-3 Nos.
Artery forceps-three each.
Needle holder- three.
=J $03*: T(9) &(< = = 2
=I IOL Operaon set 2 2 C
=O YAG Laser = = =
20 Operang Microscope = = =
21 A-Scan Biometer = = =
22 S(0*</;(<(0 = = =
23 7?</ F(50*6</;(<(0 = = =
24 Flash Autoclave = = =
25 Applanaon Tonometer 1 (Desirable) 1 (Desirable) 1 (Desirable)
26 Phacomachine 1 (Desirable) 1 (Desirable) =
27 Laser Photocoagulator* 1 (Desirable) 1 (Desirable) 1 (Desirable)
* To be supplied by Blindness Control Society 1 (Desirable)
20 PMT sets (mouth mirror, probe dental and
tweezer).
Excavators.
Filling instruments.
Micromotor with straight and contra angle
hand piece.
3. Minor Surgical Instruments.
4. Perio Surgical Instrument-One Complete Set.
5. Endodonc Instruments.
6. Hands Scaler Set Blopsy.
7. Pulp Tester.
8. Trays For Complete/Partlal Edentulous Paents For
Making Of Complete/paral Denturs Of Dierent Sizes.
9. Ster|||zer
Autoclave small front loading-one
Boiler (sterilizer) - One
@0())39+ 20?;
10. Execuve Chair Revolving
11. Chair metal for oce use
12. Oce table
13. Recovery room with one bed and oxygen cylinder
with trolley and gas.
14. Trolley and wheel chair for paents
15. Wall clock
16. Dental I.O.P. X-ray machine with X-ray developing
facilies.
17. Chairs for waing paents-20.

46
= Auto Clave HP Horizontal = M9 !&&@ = =
2 Auto Clave HP Vercal (2 bin) 2 In CSSD D D
C Operaon Table Ordinary Paediatric*
D Operaon Table Hydraulic Major 2 D D
E Operaon table Hydraulic Minor 2 D D
H Operang table non-hydraulic eld type = 2 2
J Operang table Orthopedic* = =
I Autoclave with Burners 2 bin*
O Autoclave vercal single bin = 2 C
=K Shadowless lamp ceiling type major* = 2 C
== Shadowless lamp ceiling type minor* = = 2
12 Shadowless Lamp stand model = C C
=C Focus lamp Ordinary 2 D D
=D Sterilizer (Big instruments) 2 C
=E Sterilizer (Medium instruments) C E
=H Sterilizer (Small instruments) C E
=J Bowl Sterilizer Big 2 C
=I Bowl Sterilizer Medium = =
=O Diathermy Machine (Electric Cautery) = = =
20 Sucon Apparatus - Electrical D E H
21 Sucon Apparatus - Foot operated C D E
22 Dehumidier* = = =
23 Ultra violet lamp philips model 4 feet D I I
24 Ethylene Oxide sterilizer* 1 (Desirable) 1 (Desirable) =
25 Microwave sterilizer* = = =
26 Intense Pulse Light Machine - - =
27 Ultrasonic cung and coagulaon device - - 1 (Desirable)
28 Plasma Sterilizer - - 1 (Desirable)
29 U:<0*)/936 6:(*9(0 - - 4 (Desirable)
IX. Operaon Theatre Equipment
S|. No. Name of the Lqu|pment 101-200 8edded and
201-300 8edded
301-S00 8edded
= Binocular Microscope H =K
2 Chemical Balances 2 2
C &3;B:( R*:*96() 2 2
D %:(6<036 !*:/03;(<(0 2 2
E Fully Automated Auto-analyser =
H Semi auto analyser = =
J Micro pipees of dierent volumes =K =K
X. Laboratory Equipment
47
201-300 8edded
301-S00 8edded
I Water bath 2 2
O A/< 730 /-(9 C 2
=K T*R M96?R*</0 C C
== Dislled water Plant 2 2
12 Electricentrifuge, table top C C
=C !(:: !/?9<(0 %:(6<0/936 = =
=D A/< B:*<() C H
=E Rotor/Shaker C 2
=H Counng chamber C D
=J 4A ;(<(0 2 C
=I Paediatric Glucometer/Bilirubinometer =
=O >:?6/;(<(0 1+1 2
20 A*(;/+:/R39/;(<(0 2 C
21 $!@! 6/?9< *BB*0*<?) = 2
22 ESR stand with tubes D H
23 $()< <?R( )<*92) H 10 20
24 $()< <?R( 0*68 H 10 20
25 Test tube holders H 10 20
26 &B303< :*;B I =K
27 Rotatry Microtome = =
28 Wax Embel Bath - =
29 Auto Embedic Staon =Y =Y
CK Timer stop watch 2 2
C= 7:*0; 6:/68 = 2
32 Elisa Reader cum washer = 2
CC Blood gas analyser = =
CD Electrolyte Analyser = =
CE Glycosylated Haemoglobinometer = =
CH Blood Bank Refrigerator C C
CJ Haematology Analyser with 22 parameters = =
CI Blood Collecon Monitor = =
CO Laboratory Autoclaves C C
DK Blood Bank Refrigerator D D
D= Ordinary Refrigerator C D
42 Floataon Bath = =
DC Emergency Drug Trolley with auto cylinder = =
DD @3*:(6<(2 $?R( &6*:(0
DE Class I Bio Safety Cabinet = =
DH Knife Sharpner = =
DJ Air Condioner with Stabilizer = =
48
201-300 8edded
301-S00 8edded
DI Cyto Spin = =
DO F" 4:*9< = =
EK Computer with UPS and Printer = =
E= Automac Blood Gas Analyzer = =
52 Fine Needle Aspiraon Cytology = =
EC Histopathology Equipment = =
EDYY Pipee 1 ml & 5 ml
Buree 10 ml
!/936*: .:*)8
Biker/Glass boles
Glass or plasc funnel
Glass srring rod
&;*:: )<*39:()) )<((: R/1:
Electronic weighing scale
Measuring cylinder
Gas Burner
Laboratory balance
Stop watch, Cyclomixer
Micro pipee 10-100 ml
:10-200 ml
'360/ $3B)
Centrifuge, Oven
Bath Serological
@3+3<*: 6*:/03( ;(<(0
Srrer with stainless steel srring rod
@3+3<*: (:(6<0/936 <(;B(0*<?0( 6/9<0/::(0
EEYYY i. Ion meter Table Top (specic for uoride
esmaon in biological uid)
ii. Table Top Centrifuge without refrigeraon
iii. Digital PH Meter
iv. Metaler Balance
v. Mixer
vi. Incubator
vii. Pipees/Micropipees
EH CO Analyser = =
EJ Dry Biochemistry 1 (desirable)
EI Whole Blood Finger Prick HIV Rapid Test and STI
Screening Test each
DKKK DKKK
EO Blood Component Separator =
HK 4:*<(:(< 7+3<*</0 =
H= Platelet Thawing Machine =
62 T*;39*0 .:/1 =
** To be provided for salt and Urine analysis for Iodine.
*** For analysis of Fluoride wherever applicable.
49
= P.S. set 2 2 2
2 MTP Set (Including Sucon Cannula size 6-12) 2 2 D
C Biopsy Cervical Set* = 2 2
D EB Set 2 C E
E Microscope (Gynae for wet smear and PCT ) - = =
H D&C Set 2 2 E
J I.U.C.D. Kit 2 2 2
I T&!& )(< 2 2 E
O 'P7 S3< 2 2 C
=K Vaginal Hysterectomy 2 2 2
== Proctoscopy Set* 2 2 C
12 P.V. Tray* 2 C C
=C Abdominal Hysterectomy set 2 2 2
=D Laparotomy Set 2 C E
=E ./0;*:39( 23)B(9)(0 C D E
=H Kick Bucket I =K =E
=J General Surgical Instrument Set Piles, Fistula,
.3))?0(Y
2 2 2
=I Knee hammer E E E
=O Hernia, Hydrocele* 2 2 2
20 P*036/)( -(39 (<6Y = = 2
21 Gynaec Electric Cautery = = =
22 Vaginal Examinaon set* I =E 20
23 &?<?039+ &(<Y E J =K
24 MTP sucon apparatus = 2 2
25 Thoracotomy set = =
26 Neuro Surgery Craniotomy Set = =
27 M ' #*3:39+ S3< = 2 2
28 &4 #*3:39+ = 2 2
29 Compression Plang Kit* = 2 2
CK AM Prosthesis* = =
C= Dislocaon Hip Screw Fixaon* = =
32 Fixaon Fracture Hip = = =
CC Spinal Column Back Operaon Set = =
CD Thomas Splint J O =K
CE Paediatric Surgery Set = 2 2
CH Mini Surgery Set* 2 2 2
QM &?0+36*: %G?3B;(9< &(<)
50
CJ Urology Kit = = 2
CI Surgical Package for Cholecystectomy* = =
CO Surgical package for Thyroid = =
DK GI Operaon Set* 2 2 D
D= Appendicectomy set* 2 2 2
42 L. P. Tray* E J J
DC Uretheral Dilator Set D D H
DD $UF4 0()(6</)6/B(Y = = =
DE Haemodialysis Machine* @()30*R:( = = 2
DH Amputaon set = 2 2
DJ Universal Bone Drill @()30*R:( = 2
DI !0*;;(0 130( )B:39<) I =K 12
DO Minilap sets-3 C C C
EK NSV sets-3 C C C
E= !/:B/)6/B( = = =
52 Cryoprobe = = =
EC Skin Biopsy Sets = 2 C
S|. No. Name of the Lqu|pment Ior a|| D|str|ct
nosp|ta|s
= Skeleton tracon set C
2 Interferenal therapy unit 2
C Short Wave Diathermy =
D Hot packs & Hydro collator 7) B(0 9((2
E %L(063)( $*R:( 7) B(0 9((2
H Stac Cycle 7) B(0 9((2
J '(23639( R*:: 7) B(0 9((2
I [?*2036*B) %L(063)(0 7) B(0 9((2
O Coordinaon Board 7) B(0 9((2
=K Hand grip strength
measurement Board
7) B(0 9((2
== Kit for Neuro-development
*))());(9<
7) B(0 9((2
12 CBR Manual 7) B(0 9((2
=C ADL Kit & hand exerciser 7) B(0 9((2
=D Mul Gym Exerciser 7) B(0 9((2
=E &(:5 A(:B 2(-36() 7) B(0 9((2
=H Wheel chair 7) B(0 9((2
XII. PMR* Equipment
S|. No. Name of the Lqu|pment Ior a|| D|str|ct
nosp|ta|s
=J Crutches/Mobility device
)(<)
7) B(0 9((2
=I A/< *30 /-(9 2
=O A/< *30 +?9 2
20 >0392(0 2
21 &*92(0 2
22 F/?<(0 7) B(0 9((2
23 4/1(0 @03:: 7) B(0 9((2
24 Band saw 7) B(0 9((2
25 P*6??9 5/0;39+ *BB*0*<?) 7) B(0 9((2
26 Lathe 7) B(0 9((2
27 Welding machine 7) B(0 9((2
28 Bung & polishing
machine
7) B(0 9((2
29 Work table 2 nos 2
CK $//:) *92 0*1 ;*<(03*: 7) B(0 9((2
Y
As PMR services would be provided with the posng of qualied paramedical
these are all required equipment including items for use in the orthoc &
Prosthec workshop.
51
= Endoscope bre Opc (OGD)* = @()30*R:( = =
2 Arthroscope = @()30*R:( = =
C Operang Laproscope complete for laproscopic
surgery
= @()30*R:( = =
D Laparoscope diagnosc and for sterilisaon* = 2 2
E !/:/9/)6/B( *92 )3+;/32/)6/B(Y = @()30*R:( = =
H Hysteroscope* = = =
J !/:B/)6/B(Y = = =
I Cystoscope = @()30*R:(
XIII. Endoscopy Equipment
= Anesthec - laryngoscope magills with four blades C E I
2 Endo tracheal tubes sets 2 C C
C Magills forceps (two sizes) H I =K
D !/99(6</0 )(< /5 )3L 5/0 %$$ H I =K
E Tubes connecng for ETT H =K =K
H Air way female* =K =K =K
J Air way male* 20 20 20
I Mouth prop* I =K =K
O $/9+?( 2(B0())/0)Y =K 12 =E
=K "
2
cylyinder for Boyles =K 12 =H
== #
2
O Cylinder for Boyles =K 12 =H
12 !"
2
cylinder for laparoscope* E =K
=C PFT machine = = =
=D Anaesthesia machine with venlator (desirable)/
Boyles Apparatus with Fluotec and circle absorber
2 C D
=E Mul-parameter monitor 2 C D
=H Pipe line supply of Oxygen, Nitrous Oxide,
Compressed Air and sucon (desirable)
=J Debrillators = 2
=I M95?)3/9 B?;B)Y
=O Regional anaesthesia devices*
20 "
2
therapy devices*
21 Exchange Transfusion Sets*
kecovery Area
22 O2 therapy devices*
23 Pipe line supply of Oxygen and Sucon (desirable)
24 '/93</0Y
25 Paent trolley*
XIV. Anaesthesia Equipment
52
= Doctors chair for OP Ward, Blood Bank, Lab etc. CK EK HK
2 Doctors Table 20 CK DK
C Duty Table for Nurses =K =E 20
D Table for Sterilisaon use (medium) I 12 20
E Long Benches (6 x 1 ) CK DK EK
H &<//: N//2(9 CK DK EK
J &<//:) F(-/:-39+ =K =E 20
I Steel Cup-board 20 25 DK
O Wooden Cup Board =K =E 20
=K Racks -Steel Wooden =K 12 =E
== Paents Waing Chairs (Moulded)* 20 CK EK
12 Aendants Cots* =K =E 20
=C Oce Chairs H I =E
=D Oce Table H =K =E
=E .//< &<//:)Y 20 CK DK
=H Filing Cabinets (for records)* I =K 12
=J M.R.D. Requirements (record room use)* = = =
=I Paediatric cots with railings E E =K
=O !0*2:(Y C E J
20 Fowlers cot = 2 C
21 Ortho Facture Table* = = =
22 Hospital Cots (ISI Model) 200 CKK DIK
23 Hospital Cots Paediatric (ISI Model) =K =E DK
24 Wooden Blocks (Set)* C E J
25 Back rest* H I =K
26 Dressing Trolley (SS) H I =K
27 Medicine Almairah C E E
28 Bin racks (wooden or steel)* I =K =E
29 M!!U !/<) H H I
CK Bed Side Screen (SS-Godrej Model)^
H
7) B(0
0(G?30(;(9<
7) B(0
0(G?30(;(9<
C= Medicine Trolley (SS) H I =K
32 Case Sheet Holders with clip (S.S.)* IK 120 =EK
CC Bed Side Lockers (SS)* K K K
CD Examinaon Couch (SS) C E J
CE Instrument Trolley (SS) I =K =E
CH Instrument Trolley Mayos (SS) D H I
CJ Surgical Bin Assorted CK DK EK
CI Wheel Chair (SS) H =K =E
CO Stretcher/Paence Trolley (SS) E =K =E
DK Instrument Tray (SS) Assorted EK HK JE
XV. Furniture & Hospital Accessories
53
D= Kidney Tray (SS) - Assorted EK HK JE
42 Basin Assorted (SS) EK HK JE
DC Basin Stand Assorted (SS)
(2 basin type) I =K =E
(1 basin type) =K =E 20
DD Delivery Table (SS Full) I =K 12
DE Blood Donar Table* = 2 2
DH "
2
Cylinder Trolley (SS) =K 12 =E
DJ Saline Stand (SS) CK EK HK
DI Waste Bucket (SS)* EK JE =KK
DO @3)B(9)39+ $*R:( N//2(9 = 2 2
EK Bed Pan (SS)* CK DK EK
E= U039*: '*:( *92 .(;*:( CK DK EK
52 Name Board for cubicals* = = =
EC Kitchen Utensils*
ED Containers for kitchen*
EE Plate, Tumblers*
EH Waste Disposal - Bin/drums =K =E 20
EJ Waste Disposal - Trolley (SS) 2 C C
EI Linen Almirah C E E
EO Stores Almirah C E E
HK Arm Board Adult* =K =E 20
H= Arm Board Child* =E =E 20
62 SS Bucket with Lid I =K =E
HC Bucket Plasc* =K =K 20
HD 7;R? R*+) H =K =K
HE "
2
Cylinder with spanner ward type CK DK EK
HH Diet trolley - stainless steel 2 2 2
HJ Needle cuer and melter 20 25 25
HI Thermometer clinical* 25 CK DK
HO Thermometer Rectal* D E E
JK Torch light* =K 12 12
J= Cheatles forceps assored* =K 12 =E
72 Stomach wash equipment* D E H
JC M950* F(2 :*;BY E E J
JD Wax bath* = 2 2
JE Emergency Resuscitaon Kit-Adult* 2 2 2
JH %9(;* &(<Y H I =K
JJ ICU Bed (For Eclampsia) - - 2
JI !(:39+ .*9Y
^ At least one screen per ve beds except female wards.
54
XVI. Post Mortem Equipment
S|. No. Name of the Lqu|pment 101-200
8edded
201-300
8edded
301-S00
8edded
= Mortuary table (Stainless steel)* 2 2 2
2 P.M.equipment (list) D H H
C Weighing machines (Organs) 2 2 2
D Measuring glasses (liquids) C D D
E 7B0/9)Y =K =K =K
H PM gloves (Pairs)* =K 20 20
J Rubber sheets*
I T(9) 2 2 2
O Spot lights 2 D D
XVII. Linen
= Bedsheets IKK 1200 2000
2 Bedspreads 1200 =IKK CKKK
C Blankets Red and blue EK =KK 125
D 4*<9* </1(:) CKK =KKK =EKK
E Table cloth HK JE =KK
H Draw sheet =KK =EK 200
J Doctors overcoat HK OK =EK
I A/)B3<*: 1/08(0 "$ 6/*< 250 DKK EKK
O Paents house coat (for female) HKK OKK =EKK
=K Paents Pyjama (for male) Shirt CKK DKK HKK
== Over shoes pairs IK =KK =EK
12 43::/1) CKK DEK HKK
=C 43::/1) 6/-(0) HKK OKK =EKK
=D Maress (foam) Adult 200 CKK EKK
=E Paediatric Maress 20 DK EE
=H Abdominal sheets for OT =EK 200 250
=J Pereneal sheets for OT =EK 200 250
=I T(++39+) =KK =EK 200
=O Curtain cloth windows and doors
20 U935/0;V7B0/9
21 Mortuary sheet EK JK =KK
22 Mats (Nylon) =KK 200 CKK
23 Mackin tosh sheet (in meters) 200 CKK EKK
24 7B0/9 5/0 6//8
55
XVIII. Teaching Equipment
= Furniture for class room, commiee/meeng room = 7) B(0
0(G?30(;(9<
7) B(0
0(G?30(;(9<
2 O. H. P = = =
C &60((9 = = =
D White/colour boards = 2 2
E $(:(-3)3/9 6/:/?0 = 2 2
H Tape Recorder* (2 in 1) = = =
J VCD Player = = =
I F*23/ = = =
O T!@ 40/\(6</0) = = =
=K 1. Desk top computer (with color monitor, CPU,
UPS, laser printer & computer table)
= =
== Resuscitaon Training Mannequins = =
12 Library with Books, Training CD and Protocols
with Internet facility. subscripon to some index
\/?09*:) /5 0(B?<(
- @()30*R:( @()30*R:(
=C Female Pelvis, Fetal Skull, Fetal Mannequine One each One each One each
=D Xerox Machine, Computer with Internet in the
liberary
One each One each One each
= Computer with Modem with UPS, Printer with
Internet Connecon**
D E H
2 Xerox Machine = = =
C Typewriter (Electronic )* = = =
D Intercom (15 lines)*
E Intercom (40 lines)* = = =
H Fax Machine = = =
J Telephone = 2 2
I Paging System*
O Public Address System* = = =
** At least one for Medical Record sand one for IDSP.
XIX. Administraon
56
= F(503+(0*</0 =HE :3<0() E E E
2 Blood Bank Refrigerator = = 2
C MTF 2 2 2
D Deep Freezer 2 2 2
E &B*0( 36( B*68 R/L one from each
(G?3B;(9<
one from each
(G?3B;(9<
one from each
(G?3B;(9<
H Room Heater/Cooler for immunizaon clinic with
electrical ngs
7) B(0 9((2 7) B(0 9((2 7) B(0 9((2
J Waste disposal twin bucket, hypochlorite soluon/
bleach
2 per ILR
bimonthly
2 per ILR
bimonthly
2 per ILR
bimonthly
I Freeze Tag Need Based Need Based Need Based
O Thermometers Alcohol (stem) 2 2 2
=K Almirah for Vaccine logiscs 2 2 2
== Almirah for vaccine logiscs = = =
12 Immunizaon table E E E
=C Chair for new sta proposed C C C
=D Stools for immunizaon room 2 2 2
=E Bench for waing area = = =
=H Dustbin with lid one from each
(G?3B;(9<
one from each
(G?3B;(9<
one from each
(G?3B;(9<
=J N*<(0 6/9<*39(0 = = =
=I Hub cuers 2 2 2
=O 5 KVA Generator with POL for immunizaon
B?0B/)(
= =
=
20 !//:(0)Y 7) B(0
0(G?30(;(9<
7) B(0
0(G?30(;(9<
7) B(0
0(G?30(;(9<
21 Air condioners =K =K =H
22 !(9<0*: 7V! 5/0 "$ = = =
* One cooler per 8 beds in the wards.
= >(9(0*</0 DKVEK SP
2 >(9(0*</0 JE SP =
C Generator 125 KV = =
D Portable 2.5 KV = 2 2
E Solar Water heater*
H M9639(0*</0Y
J Central supply of 02, N20, Vacuum*
I Cold storage for mortuary*
XXI. Hospital Plants
XX. Refrigeraon & AC
57
= !(3:39+ .*9)Y EK JK 120
2 Exhaust Fan* =K 12 24
C 4(2()<*: .*9Y 2 C D
D N*:: .*9Y C D H
E A/<1*<(0 +(3)(0Y 2 2 C
H Fire exnguishers*
J Sewing Machine* 2 2 2
I T*19 '/-(0Y 2 2 2
O P*66?; 6:(*9(0Y 2 C D
=K Water purier*
== Solar water heater*
12 Neon sign for hospital*
=C >*02(9 (G?3B;(9<Y
=D Borewell motor OHT*
=E N*<(0 23)B(9)(0VN*<(0 6//:(0Y
=H Laundry (steam)*
=J Emergency lamp
=I Emergency trauma set* 2 2 C
=O Tube lights* JK 120 200
20 @039839+ N*<(0 ./?9<*39Y C D E
* To be provided as per need and fountain is desirable.
= 7;R?:*96( C C D
2 Van (Family Welfare)*
C Pickup vehicles Maru (Omni)/RTV
D Mortuary Van* = = =
E Administrave vehicle (Car)*
H Minidor 3 wheeler/Tates ace*
J Bicycle*
I Camp Bus*
O Progamme vehicle*
=K Motorcycle*
XXII. Hospital Fings & Necessies
XXIII. Transport
XXIV. Radiotherapy
Brachytherapy System
Rotaonal Cobalt Machine
Radiotherapy Simulator
Energy Linear Accelerator
Treatment Planning System
1.
2.
3.
4.
5.
High Energy Linear Accelerator
Copy of Specicaon for Major Equipment
Copy of Specicaon for Minor Equipment
High Dose Linear Accelerator 1
Linear Accelerator.
6.
7.
8.
9.
10.
58
XXV. Intensive Care Unit (ICU)
ICU should have minimum of 4 beds.
For each bed provide:
High end monitor
Venlator
O2 therapy devices
M!U R(2
S|. No. Spec|a||ty D|agnosnc Serv|ces]1ests

I C||n|ca| atho|ogy

a. Hematology

Haemoglobin esmaon
Total Leukocytes count
Dierenal Leucocytes count
Absolute Eosinophil count
Reculocyte count
Total RBC count
E. S. R.
- Immunoglobin Prole (IGM, IGG, IGE, IGA) Bleeding me
- Fibrinogen Degradaon Product Clong me

Prothrombin me
Peripheral Blood Smear
'*:*03*V.3:*03* 4*0*)3<(
4:*<(:(< 6/?9<
4*68(2 !(:: -/:?;(
Blood grouping
Rh typing
Blood Cross matching
ELISA for HIV, HCV, HBs Ag
ELISA for TB
74$$
ANA/ANF, Rhemmatoid Factor
b. Urine Analysis Urine for Albumin, Sugar, Deposits, bile salts, bile
pigments, acetone, specic gravity, Reacon (pH)

c. Stool Analysis

Stool for Ovacyst (Ph),
Hanging drop for V. Cholera
"66?:< R://2
Bacterial culture and sensivity
Deep Vein Thrombosis prevenon devices
sucon
M95?)3/9 4?;B)
Pipe line of O2, sucon and compressed air
Common facilies required in ICU:
Ultrasound for invasive procedures one
Debrillator-one
Arterial Blood Gas (ABG) Analysis machine- one.
Laboratory Services at District Hospital

The District Hospital Laboratory shall also serve the purpose of public health laboratory and should be able to
perform all tests required to diagnose epidemics or important diseases from public health point of view. Following
facilies will be ensured at all district hospital laboratories. For advanced diagnosc tests, a list of Naonal
Reference Laboratories has been provided as Annexure V.
59
d. Semen Analysis Morphology, count
e. CSF Analysis Analysis, Cell count etc.
f. Aspirated uids Cell count cytology
II

atho|ogy
a. PAP smear Cytology
b. Sputum Sputum cytology
c. Haematology

Bone Marrow Aspiraon
Immuno haematology
Coagulaon disorders
&368:( 6(:: *9*(;3*
Thalassemia
d. Histopathology All types of specimens, Biopsies
III M|crob|o|ogy
KOH study for fungus
Smear for AFB, KLB (Diphtheria)
Culture and sensivity for blood, sputum, pus, urine
etc.
Bactriological analysis of water by H
2
& R*)(2 <()<
Stool culture for Vibrio Cholera and other bacterial
enteropathogene
Supply of dierent media* for peripheral Laboratories
Grams Stain for Throat swab, sputum etc.
IV Sero|ogy RPR Card test for syphillis
Pregnancy test (Urine gravindex) ELISA for Beta HCG
Leptospirosis, Brucellosis
NM@7T <()<
Elisa test for HIV, HBsAg, HCV
DCT/ICT with Titre
F7 5*6</0
V 8|ood 8ank Services as per norms for the blood bank including
services for self component separaon
VI

8|ochem|stry

Blood Sugar
>:?6/)( $/:(0*96( $()<
Glycosylated Hemoglobin
Blood urea, blood cholesterol
&(0?; R3:30?R39
M6<(036 392(L
Liver funcon tests
Kidney funcon tests
60

Lipid Prole
Blood uric acid
&(0?; 6*:63?;
Serum Phosphorous
&(0?; '*+9()3?;
CSF for protein, sugar
Blood gas analysis
Esmaon of residual chlorine in water
Thyroid T3 T4 TSH
!4S
Chloride (Desirable)
Salt and Urine for Iodine (Desirable)
Iodometry Titraon
VII

Card|ac Invesnganons

a) ECG
b) Stress tests
c) ECHO
VIII

Cphtha|mo|ogy

a) Refracon by using Snellens chart
Renoscopy
Ophthalmoscopy
Ik LN1 Audiometry
Endoscopy for ENT
k

kad|o|ogy

a) X-ray for Chest, Skull, Spine, Abdomen, bones
b) Barium swallow, Barium meal, Barium enema, IVP
c) MMR (chest)
d) HSG
e) Dental Xray
f) Ultrasonography
g) CT scan
kI

Lndoscopy

Oesophagus
Stomach
Colonoscopy
Bronchuscopy
Arthros copy
Laparoscopy (Diagnosc)
Colposcopy
Hysteroscopy
kII kesp|ratory Pulmonary funcon tests
* Specimen collecon and transport media only.
61
Recommended Allocaon of Bed Strength
S|.
No.
Item 1ype D|str|ct neadquarters nosp|ta|
101-200 8edded 201-300 8edded S00 8edded
= >(9(0*: '(23639( Beds (M + F) 15 + 15 25 + 25 40 + 40
2 #(1R/09 1*02 Beds E E =K
C Mothers room with dining and toilets Beds E E =K
D 4*(23*<036) 1*02 Beds =K 20 DK
E Crical care ward IMCU Beds E =K =K
H Isolaon Ward Beds D E E
J Dialysis unit (as per specicaons) Beds C C
I Thoracic medicine ward with room for
pulmonary funcon test
Beds (M + F) 5 + 5 10 + 10
O Blood bank Yes Yes Yes
=K General surgery ward (incl. Urology, ENT) Beds (M + F) 15 + 15 25 + 20 35 + 35
== Post Operave Ward Beds (M + F) 10 + 16* 10 + 10 15 + 15
12 76632(9< *92 $0*?;* 1*02 Beds =K =K =E
=C T*R/?0 0//; Boards C I I
=D Labour room (Eclampsia) Beds C C
=E Sepc Labour room Boards 2 2
=H Ante-natal ward Beds =E =E CK
=J Post-natal ward Beds =E =E CK
=I 4/)<B*0<?; 1*02 Beds 20 CK EK
=O Post operave ward Beds 20 DK
20 Ophthalmology ward Beds E =K 20
21 Burns Ward Beds - E =K
* Including post caesarean paents.
Note: The hospital may earmark 5 10 addional beds for AYUSH Services, for which dedicated paramedical sta may be provided.
Requirements of Operaon Theatre
S|. No. Item D|str|ct neadquarters nosp|ta|
101-200 8edded 201-300 8edded 301-S00 8edded
= Elecve OT-Major = 2 C
2 Emergency OT/FW OT = = =
C Ophthalmology/ENT OT = = =
(Separate emergency OT for Obstetrics, Minor OT by side of Gynae. OT).
62
List of Drugs/Lab Reagents/Other Consumables and Disposables for
@3)<036< A/)B3<*:)
The List of the drugs given under is not exhausve and exclusive but has been provided for delivery of minimum
assured services.
S|. No. Name of the Drugs
A) Ana|ges|cs]Annpyrencs]Ann Inamatory
= Tab. Aspirin 300 mg
2 Tab. Paracetamol 500 mg
C Tab. Diclofenac sod
D Tab. Piroxicam 20 mg
E Tab. Ibuprofen
H Tab. Valdecoxib 20 mg (Desirable)
J Tab. Drotavarine
I Inj. Paracetamol
O Inj. Diclofenac sodium
=K Inj. Drotavarine
== Inj. Buscopan
8) Annb|oncs & Chemotherapeuncs
= Tab. Trimethoprim + Sulphamethazol ss
2 Tab. Erythromycin 250 mg
C Tab. Erythromycin 500 mg
D Tab. Noroxacin 200 mg
E Tab. Cexime
H Tab. Noroxacin 400 mg
J Tab. Ooxacin 200 mg
I Tab. Peoxacin 400 mg
O Tab. Gaoxacin 400 mg
=K Tab. Chloroquine phosphate 250 mg
== Tab. Pyrazinamide 500 mg, 750 mg
12 Tab. Erythromycine Esteararte 250 mg, 800 mg
=C Tab. Phenoxymethyl Penicillin 125 mg
=D Tab. Isoniazid 100 mg
=E Tab. Ethambutol 400 mg
=H Tab. Isoniazid + Thiacetazone
=J Tab. Furazolidone
=I Tab. Mebendazole 100 mg
=O Tab. Griseofulvin 125 mg
20 Tab. Nitrofuranon
21 Tab. Ciprooxacin 250 mg, 500 mg
22 Tab. Amoxyclav 375 mg, 625 mg
23 Tab. Azythromician EKK ;+
24 Tab. Fluconazole 150 mg
25 Cap. Ampicillin 250 mg
26 Cap. Tetracycline 250 mg
27 Cap. Cefodroxyl 250 mg
28 Cap. Amoxycillin250 + cloxacillin 250
29 Cap. Rifampicin 150 mg, 300 mg, 450 mg, 600 mg
CK Cap. Amoxycilline 250 mg, 500 mg
C= Cap. Doxycycline 100 mg
32 Cap. Cephalexin 250 mg
CC Syrup. Cotrimoxazole 50 ml
CD Syrup. Ampicillin 125 mg/5 ml, 60 ml
CE Syp. Erythromycine
CH Syp. Mebendazole
CJ Syp. Piperazine Citrate
CI Syp. Pyrantel Pamoate
CO Syp. Primaquine
DK Syp. isoniazid 100 mg/5 ml 100 ml bot
D= Syp. Nalidixic acid
42 Syp. Noroxacin
DC Suspension Pyrantel pamoate
DD Sus. Furazolidone
DE &?) F35*;B3639
DH STI syndromic drug kit
DJ Inj. Crystalline penicillin 5 lac unit
63
DI Inj. Fored procaine penicillin 4 lac
DO Inj. Ampicillin 500 mg
EK Inj. Cloxacillin
E= Inj. Gentamycin 40 mg/2 ml vial
52 Inj. Crystalline penicillin 10 lac unit
EC Inj. Metronidazole 100 ml
ED Inj. Ciprooxacin 100 ml
EE Inj. Cefoperazone 1 gm
EH Inj. cefotaxime 500 mg
EJ Inj. Ceriaxone
EI Inj. Cefotaxime
EO Inj. Cloxacillin
HK Inj. Gentamycin
H= Inj. Quinine
62 Inj. Chloramphenicol
HC Inj. Dopamine
HD Inj. Vionocef (Cexime) 250 mg
HE Inj. Amikacin sulphate 500 mg, 100 mg
HH Inj. Amoxycillin 500 mg
HJ Inj. Salbactum + Cefoperazone 2 gm
HI Inj. Amoxycillin with clavutanite acid 600 mg
HO Inj. Cefuroxime 250/750
JK Inj. Chloroquine phosphate
J= Inj. Benzathine penicillin 12 lac
72 Inj. Quinine Dihydrochloride
JC Inj. Amoxyclav 1.2 gm
JD Inj. Azythromician 500 mg
JE Inj. Ceriaxone
JH AIDS Protecve kit
C) Ann D|arrhoea|
= Tab. Metronidazole 200 mg, 400 mg
2 Tab. Furazolidone 100 mg
C Tab. Diloxanide Furoate
D Tab. Tinidazole 300 mg
E Tab. Chloroquinne/Hydry Chloriquinne
H Syrup. Metronidazole
D) Dress|ng Mater|a|]Annsepnc C|ntment |onon
= Povidone Iodine soluon 500 ml
2 Phenyl 5 litre jar (Black Phenyl)
C Benzalkonium chloride 500 ml bole
D Rolled Bandage
a) 6 cm
b) 10 cm
c) 15 cm
E Bandage cloth (100 cm x 20 mm) in Than
H Surgical Guaze (50 cm x 18 m) in Than
J Adhesive plaster 7.5 cm x 5 mtr
I Absorbent coon I.P 500 gm Net
O P.O.P Bandage
a) 10 cm
b)15 cm
=K Framycen skin Oint 100 G tube
== Silver Sulphadiazene Oint 500 gm jar
12 Ansepc loon containing:
a) Dichlorometxylenol 100 ml bot
b) Hainol 5 litre jar
=C Sterilium loon
=D Bacillocid loon
=E .?0*639 )839 /39<
=H Framycen skin oint
=J Tr. Iodine
=I Tr. Benzoin
=O 4/<*))3?; 4(0;*9+9*<(
20 Methylated spirit
21 Betadine loon
22 Hydrogen peroxide
23 Neosporin, Nebasuef, Soframycin Powder
24 Magnesium Sulphate Powder
L) Infus|on u|ds
= Inj. Dextrose 5% 500 ml bole
2 Inj. Dextrose 10% 500 ml bole
64
C Inj. Dextrose in Normal saline 500 ml bole
D Inj. Normal saline (Sod chloride) 500 ml bole
E Inj. Ringer lactate 500 ml
H Inj. Mannitol 20% 300 ml
J Inj. Water for 5 ml amp
I Inj. Water for 10 ml amp
O Inj. Dextrose 25% 100 ml bole
=K Inj. Plasma Substute 500 ml bole
== Inj. Lomodex
12 Inj. Isolyte-M
=C Inj. Isolyte-P
=D Inj. Isolyte-G
I) Lye and LN1
= Sulphacetamide eye drops 10% 5 ml
2 Framycen with steroid eye drops 5 ml
C Framycen eye drops 5 ml
D Ciprooxacin eye/ear drops
E Gentamycin eye/ear drops
H Local anbioc steroid drops
J Timolol 0.5%
I Homatropine 2%
O $0/B36*;32( =W
=K Cyclomide 1%
== N*L 23))/:-39+ (*0 20/B)
12 Anfungal (Clotrimazole) ear drops
=C Anallergic + Decongestant combinaon
eg. Chlorphenarmine + Pseudoephederine/
Phenylephrine
=D Oxmetazoline/Xylometazoline nasal drops
=E Betnesol-N/Efcorlin Nasal drops
=H Pilocarpine eye drops 1%, 2%, 4%
=J Phenylepinephrine eye drops
=I Glycerine Mag sulphate ear drops, ointment
=O Anfungal + Anbioc ear drops (clotrimazole +
polymyxin B)
20 Steroid + Anbioc ear drops (OTEK AC plus ear
drops)
21 Chloramphenicol eye oint & applicaps
22 Chloramphenicol + Dexamethsone oint
23 Dexamethasone eye drops
24 Drosyn eye drops
25 Atropine eye oint
G) Annh|stam|n|cs]ann-a||erg|c
= Tab. Diphenhydramine (eqv. Benadryl)
2 Tab. Cetrizine
C Tab. Chlorpheniramine maleate 4 mg
D Tab. Diethylcarbamazin
E Tab. Beta-hisdine 8 mg
H Tab. Cinnarazine 25 mg
J Tab. Desloratedine
I Tab. Levocetrizine 5 mg
O Inj. Nor adrenaline
=K Inj. Methyl Prednisolon 500 mg vial
== Inj. Adrenaline Bitartrate IP
12 Inj. Pheniramine maleate
n) Drugs acnng on D|gesnve system
= Tab. Cyclopam
2 Tab. Piperazine citrate
C Tab. Bisacodyl
D Tab. Perinorm
E Tab. Belladona
H Tab. Antacid
J Tab. Ranidine
I Tab. Omeprazole
O Tab. Liv52
=K Syp. Antacid
== Syrup Liv52
12 Liquid paran
=C Inj. Perinorm
=D Inj. Cyclopam
=E Inj. Prochlorperazine (Stemel)
=H Inj. Ranidine 2 ml
=J Inj. Metoclopramide
65
=I !*)<(0 /3:
=O Glycerine Suppositories
20 Glycerine Suppository USP 3 gm bo/10
I) Drugs re|ated to noemopoenc system
= Tab. Ferrous sulphate 200 mg, 300 mg
2 Tab. Ferrous sulphate 200 mg + Folic acid
C Syp. Ferrous Gluconate 100 ml bole
D Inj. Iron Dextran/Iron sorbitol
I) Drugs acnng on Card|ac vascu|ar system
= Tab. Digoxine
2 Tab. Atenolol
C Tab. Isoxuprine
D Tab. Methyldopa
E Tab. Isosorbide Dinitrate (Sorbitrate)
H Tab. Propranolol
J Tab. Verapamil (Isopn)
I Tab. Enalepril 2.5/5 mg
O Tab. Metoprolol
=K Tab. Captopril
== Tab. Clopidogrel
12 Tab. Atrovastan 10 mg
=C Tab. Glyceryl Trinitrate
=D Tab. Amlodipine 5 mg, 10 mg
=E Tab. Nedipine 10 mg, 20 mg, 30 mg
=H Inj. Mephenne
=J Inj. Duvadilan
=I Inj. adrenaline
=O Inj. atropine sulphate
20 Inj. Digoxine
21 Inj. Glyceryl Trinitrate
22 Inj. Streptokinase 7.5 lac vial
23 Inj. Streptokinase 15 lac vial
24 Inj. Dopamine
25 Hydrochlorthiazide 12.5, 25 mg
26 N*05*039 )/2 E ;+
k) Drugs acnng on Centra|]per|phera| Nervous
system
= Tab. Haloperidol
2 Tab. Diazepam 5 mg
C Tab. Phenobarbitone 30 mg, 60 mg
D Tab. Pacitane
E Tab. Surmonl
H Tab. Risperidone 2 mg
J Tab. Imipramine 75 mg
I Tab. Diphenylhydantoin 100 mg
O Tab. Lithium Carbonate 300 mg
=K Tab. Lorazepam 2 mg
== Tab. Olanzapine 5 mg (Desirable)
12 Tab. triuoperazine(1 mg)
=C Tab. Phenobarbitone 30 mg, 60 mg
=D Tab. Alprazolam 0.25 mg
=E Tab. Amitryplline
=H Cap. Fluoxene 20 mg
=J Syrup Phenergan
=I Syrup Paracetamol
=O Inj. Pentazocine (Fortwin)
20 Inj. Pavlon 2 ml amp
21 Inj. Chlorpromazine (Largacl) 25 mg, 100 mg
22 Inj. Promethazine Hcl Phenergan
23 Inj. Pethidine
24 Inj. Diazepam 5 mg/ml
25 Inj. Haloperidol
26 Inj. Promethazine 50 mg
27 Inj. Fluphenazine 25 mg
28 Inj. Phenytoin
29 Inj. Phenobarbitone
CK Inj. Lignocaine 1%, 2%, 5%
C= Inj. Hylase (Hyaluronidase)
32 Inj. Marcaine
CC Inj. Lignocaine Hcl 2%, 4%
CD Inj. Phenabarbitone 200 mg
66
CE Xylocaine jelly
CH Carbamazepine Tabs. syrup
CJ Ethyl chloride spray
CI Ether Anaesthec 500 ml
CO T3+9/6*39( /39<
DK Halothane
L) Drugs acnng on kesp|ratory system
= Tab. Aminophylline
2 Tab. Deriphylline
C Tab. Salbutamol 2 mg, 4 mg
D Tab. Theophylline
E Syp. Salbutamol 100 ml bot
H Syp. Theophylline 100 ml
J Syrup Noscopin
I Syrup Tedral
O Nebulisable Salbutamol nebusol soluon (to be
used with nebuliser)
=K Cough syrup 5 litre Jar
== Cough syrup with Noscapine 100 ml
12 T396<?) 6/2(39 EKK ;: R/<
=C Inj. Aminophylline
=D Inj. Deriphylline
=E Inj. Theophylline Etophylline
=H Inj. Terbutaline
M) Sk|n C|ntment]Lonon etc.
= Clotrimazole loon
2 Lot.Gamabenzene hexachloride 1% bt
C Calamine Loon BPC
D Clotrimazole cream
E Burnion Oint
H Benzyl Benzoate emulsion 50 ml bot
J .:(;3+(: 74! "39<;(9<
I Cream Fluconozole 15 gm tube
O Cream Miconozole 2% 15 gm tube
=K Cream Clotrimazole skin 1% 15 gm
== Cream Framycn 1% 20 gm tube/100 gm
12 Cream Nitrofurazone 0.2% jar of 500 g
=C Renoic Acid 0.025% Cream/Gel
=D Oint. Hydrocorsone acetate
=E Oint Acyclovir 3% 5 gm tube
=H Oint Betamethasone with and without Neomycim
=J Oint Dexamethasone 1% + Framycen
=I Oint contain clotrimazole + Genta + Flucon
=O Oint Flucanazole 10 mg
20 Oint Silversulphadiazene 1% 25 g
21 Coat Tan/Salicylic Acid Ointment
22 Salicylate Acid Ointment
23 Benzoyl Peroxide Gel 2.5/5%
N) Drugs acnng on UroGen|ta| system
= Tab. Frusemide 40 mg
2 Syp. Poassium chloride 400 ml bot
C Inj. KCL
D Inj. Frusemide
E Inj. Sodabicarb
C) Drugs used |n Cbstetr|cs and Gyneco|ogy
= Tab. Labetolol 100 ml
2 Tab. Medroxy Progestrone Acetate 10 mg
C Tab. Ethanyl Estradiol 1 mg, 2 mg
D Tab. Pyrazinamide 500 mg, 750 mg
E Tab. Ondensetron 4 mg
H Tab. Mesoprostol
J Tab. Cabergoline 0.5 mg
I Tab. Trenaxamic Acid 500 mg
O Tab. Ritodine 10 ml
=K Tab. Duvadilan
== Tab. Methyl Ergometrine
12 Tab. Primolut-N
=C Tab. slboesterol
=D T?R36 >(:
=E Dinoprostone (Cervigel) Gel
=H Clotrimazole Vaginal Tab. 100 mg
=J Clotrimazole + Clindamicin 100 + 100 mg,
Vaginal Tav.
67
=I Betadine Vaginal Tab.
=O Haymycin vaginal tab
20 Inj. Hydroxy Progesterone 500 mg/2 ml
21 Inj. MethylErgometrine 0.2 mg/amp
22 Inj. Ethacredin lactate (Emcredyl)
23 Inj. Valethemide Bromide (Epidosyn)
24 Inj. Methotrexate
25 Inj. Trenaxamic Acid 500 mg
26 Inj. Ritrodine 10 ml, 50 mg
27 Inj. Ondensetron 4 mg
28 Inj. Betamethasone 8 mg
29 Inj. Magnesium Sulphate 20%. 50%
CK Inj. Pitocin
C= Inj. Prostodin
32 Inj. Mesoprostol
CC Inj. Duvadilan
CD Inj. Magnessium Sulphate
CE Inj. Dilann Sodium
) normona| reparanon
= Tab. Biguanide
2 Tab. Chlorpropamide 100 mg
C Tab. Prednisolone 5 mg
D Tab. Tolbutamide 500 mg
E Tab. Glibenclamide
H Tab. Betamethasone
J Tab. Thyroxine sod 0.1 mg
I Testesterone Depot 50 mg (Desirable)
O Insulin lente Basal
=K Inj. Insulin Rapid
== Inj. Cry Insulin
12 Inj. Mixtard (Desirable)
=C Inj. Testesterone plain 25 mg (Desirable)
=D Inj. Dexamethasone 2 mg/ml vial
) V|tam|ns
= Tab. Vit "A" & "D"
2 Tab. Ascorbic acid 100 mg
C Tab. B. Complex NFI Therapeuc
D Tab. Polyvitamin NFI Therapeuc
E Tab. Calcium lactate
H Tab. Folic acid
J Tab. Riboavin 10 mg
I Tab. Ascorbic Acid 500 mg
O Tab. Calcium Citerate 1000 mg
=K Syp. Vitamin B. Complex
== Inj. Vit "A"
12 Inj. Cholcalciferol 16 lac
=C Inj. Ascorbic acid
=D Inj. Pyridoxin 10 mg, 50 mg
=E Inj. Vit K, Inj. Vit K
C
(Menadione)
=H Inj. Calcium Gluconate
=J Inj. Vitamin B Complex 10 ml
=I Inj. B12 Folic acid
=O Inj. Pyridoxine
20 Inj. Calcium pantothernate
21 Inj. B12 (Cynacobalamine)
22 Inj. Folinic Acid
23 Inj. Mulvitamin I.V
24 Vit D-3 Granules
k) Cther Drugs & Mater|a| & M|sce||enous |tems
= Tab. Dipyridamol (Like Persenne)
2 Tab. Seplin
C Tab. Cystone
D Tab. Gasex
E Sy. Orciprenaline
H Sy. Himalt-X (Desirable)
J Sy. Protein (Provita) (Desirable)
I Syp. Himobin
O Syp. Mentat
=K All Glass Syringes
a) 2 ml
b) 5 ml
c) 10 ml
68
d) 20 ml
== Hypodermic Needle (Pkt of 10 needle)
a) No. 19
b) No. 20
c) No. 21
d) No. 22
e) No. 23
f) No. 24
g) No. 25
h) No. 26
12 Scalp vein sets No.
a) 19
b) 20
c) 21
d) 22
e) 23
f) 24
g) 25
h) 26
=C >(:6/ *:: 9?;R(0)
=D &?0+36*: >:/-()
a) 6"
b) 6 "
c) 7"
d) 7.5"
=E Catgut Chromic
a) 1 No.
b) 2 No.
c) 1-0 No.
d) 2-0 No.
e) 8-0
=H Vicryl No. 1
=J Sutupak 1, 1/0, 2, 2/0
=I 40/:(9(
=O X Ray lm 50 lm packet (in Pkt) size
a) 6 x 8 "
b) 8" x 10"
c) 10" x 12'
d) 12" x 15"
20 MP &(<)
21 Catheters
22 Urine Bags
23 Venow
24 .3L(0
25 @(-(:/B(0
26 Ultrasound scan lm
27 Dental lm
28 Oral Rehydraon powder 27.5 g
29 Suturing needles (RB,Cung)
CK Benzyl Benzoate
C= GammaBenzene Hexachloride
32 Chlorhexidine munthmash
CC Glycerol Tannic Acid Paint (oral)
CD Betadine mouthwash
CE $03*;639/:/9( 76(</932( 39 /0*R*)( B*)<(
CH Imiquimod cream (Topical applicaon)
CJ Comp. Podophylline in Tincture Benzoin
CI >?; 4*39<
CO '3L<?0( 7:8*:39(
DK Formaldehyde Loon
D= Cetrimide 100 ml bo 3.5%, 1.5% 1
42 Bacitrium powder 10 mg bos
DC Bleaching Powder 5 Kg Pkts (ISI Mark)
DD Ether Solvent
DE Sodium Hypochloride Sod. 5 ltrs/1 ltrs
DH Tetanus Antoxin 10000 I.U (Dersirable)
DJ Hearing Aids (Behind the Ear Type) 200 per
district per year under NPPCD
DI Surg|ca| Accessor|es for Lye
Green Shades
Blades (Carbon Steel)
Opsite surgical gauze (10 x 14 cm.)
8-0 & 10-0 double needle suture
Visco elascs from reputed rms
DO Spectac|es
For operated Cataract Cases (aer refracon)
For Poor school age children with refracve
(00/0)
EK Rubber Mackintosch Sheet in mtr
E= Sterile Infusion sets (Plasc)
52 Ansera
I) A 5 ml
II) B 5 ml
III) D 5 ml
IV) AB 5 ml
EC An Rabies Serum (ARS)
ED Coir Maress
69
EE Glacial acec acid
EH Benedict soluon
EJ Glycerine
EI Turpenne oil
EO Formaldehyde
HK @(L<0/)( 4/12(0
H= %!> F/::
62 Oint. Pilex
HC Rumalaya Gel
HD Pinku Pedrac Cough Syp.
HE Inj. Heparin sod.1000 IU
HH Inj. Tetglobe
HJ Inj. Diphthoria anon (ADS) 10000 I.U
HI Inj. Gas gangrene Antoxin (AGGS) 10000
HO Inj. PAM
JK Inj. Rabipur
J= Inj. Anrabies vaccine
72 Inj. Ansnake venom (Polyvalent)
JC Inj. AnDiphtheria Serum (Desirable)
JD Inj. Cyclophosphamide
Vacc|nes Drugs and Log|sncs
JE P*6639()
JH AD syringes
JJ Reconstuon syringes
JI Red Bags
JO Black bags
IK P3*: "B(9(0
I= P3<*;39 7
82 4*0*6(<*;/:
IC Emergency Drug Kit
* nep 8 wherever |mp|emented under UI and IL |n se|ect d|str|cts
Essenal Medicines and Supplies for Special Newborn Care Unit
Item Item
Emergency Life Saving Drugs*
1. Injecon Adrenaline (1:10000)
2. Injecon Naloxone
3. Sodium Bicarbonate
4. Injecon Aminophylline
5. Injecon Phenobarbitone
6. Injecon Hydrocorsone
7. 5%, 10%, 25% Dextrose
8. Normal saline
9. Injecon Ampicillin with Cloxacillin
10. Injecon Ampicillin
11. Injecon Cefotaxime
12. Injecon Gentamycin
Other Essenal Medicines and Supplies for
&B(63*: #(1R/09 !*0( U93<
4.5% Dextrose Normal Saline
Injecon Potassium Chloride 15%
Injecon Calcium Gluconate 10%
Injecon Magnesium Sulphate 50%
Injecon Vitamin K
1.
2.
3.
4.
5.
Injecon Phenobarbitone
Injecon Phenytoin
Phenobarbitone Syrup
Amoxycillin-Clavulanic Suspension
Injecon Dexamethasone
Anfungal Skin Cream
Anbioc Skin Cream
2% Glutaraldehyde
Reced Spirit
Povidone Iodine Soluon
Lysol
&*-:/9
Liquid hand washing soap
Detergent for Washing Machine
Hand washing soap
Triple dye
Genan violet 1%
Anbioc Eye Drop
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
* This is not an exhausve list for an emergency situaon in any Sick Newborn Care Units. A stock of 1 set per bed per month should always be maintained
in the unit
70
Capacity Building
$0*3939+ /5 *:: 6*20() /5 1/08(0) *< B(03/236 39<(0-*:)
is an essenal component of the IPHS for district
hospitals. Both medical and paramedical sta should
undergo connuing medical educaon (CME) at
intervals.
District hospitals also should provide the opportunity for
the training of medical and paramedical sta working
in the instuons below district level such as skill
birth aendant training and other skill development/
management training. Training need assessment/Skill
Gap analysis should be done on regular basis and
trainings should be planned accordingly. There should
R( B0/-3)3/9 5/0 <*839+ <0*3939+ 5((2R*68 *92 *))())39+
training eecveness.
Quality Assurance and Quality
!/9<0/: /5 40/6())() *92 &(0-36(
Delivery
Quality of service should be ensured at all levels.
Standard treatment protocols for locally common
23)(*)() *92 23)(*)() 6/-(0(2 ?92(0 *:: 9*<3/9*:
programmes should be made available at all district
hospitals. Hospital should develop and implement
standard operating procedures for the critical
administrative and clinical processes. Relevant
work instructions and clinical protocols should be
displayed at point of use. For proper monitoring and
delivery of services District hospitals would develop
and implement checklists for various processes ie.
Housekeeping Checklist, BMW Checklist, Surgical
Safety Checklist etc. District Hospitals should prepare
themselves and try get certification/ Accreditation
against prevalent standards like ISO, NABH, NABL, JCI
etc.
Following processes can be taken under quality
*))?0*96( B0/+0*;
Adm|n|stranve rocesses
Paent Registraon, Admission & Discharge
'*9*+(;(9<
Hospital Stores & Inventory Management
Procurement & Outsourcing Management
1.
2.
3.
Hospital Transportaon Management
Hospital Security & Safety Management
Hospital Finance & Accounng Management
A/)B3<*: M950*)<0?6<?0(V%G?3B;(9< '*39<(9*96(
'*9*+(;(9<
Hospital housekeeping & General Upkeep
'*9*+(;(9<
Human Resource Development & Training
'*9*+(;(9<
Dietary Management
Laundry Management
A/)B3<*: N*)<( '*9*+(;(9<
C||n|ca| rocesses
Outdoor Paent (OPD) Management
In-Paent (IPD) Management (General/Crical/
Intensive Care)
Hospital Emergency and Disaster Management
Maternity and Child Health Management
Operaon Theatre and CSSD Management
Hospital Diagnosc Management
Blood Bank/Storage Management
Hospital Infecon Control Management
Data and Informaon Management
A/)B3<*: F(5(00*: '*9*+(;(9<
Pharmacy Management
'*9agement of Death
Some of quality assurance measures are already
described under departmental requirements.
Quality Control
M9<(09*: '/93</039+
a) Management Informaon System
Hospital should collect data pertaining to performance
of dierent departments and hospital as a whole.
4.
5.
6.
7.
8.
9.
10.
11.
12.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
71
A standard format for capturing key performance
39236*</0) 3) +3-(9 39 Annexure VII. 1h|s |s on|y a
suggesnve format and States may mod|fy |t as per
the|r requ|rement. These performance indictors shall
regularly be monitored and analyzed. The ndings
of MIS shall be discussed in meengs of Rogi Kalyan
Sami and hospital monitoring commiee. Correcve
and prevenve acons shall be taken to improve the
performance.
b) Internal Audit
Internal audit of the services available in the hospital
should be done on regular basis (preferably quarterly).
Findings of audit shall be discussed in meengs of
hospital monitoring commiee and correcve and
prevenve acon shall be taken. Internal audit shall
be done through hospital monitoring commiee.
This shall comprise of civil surgeon/CMO, medical
superintendent, deputy medical superintendent,
departmental in charge, Nursing Administrator and
hospital manager.
c) Medical audit
A medical audit commiee shall be constuted in
the hospital. Audit shall be done on regular basis
(preferably monthly). Sample size for audit shall be
decided and records of paents shall be selected
randomly. Records shall be evaluated for completeness
against standard content format, clinical management
of a parcular case.
d) Death review
Review of the all mortality that occurs in the hospital
shall be done on fortnightly basis. All maternal deaths
at hospital shall come under this preview. A facility
based maternal death review format is given in
Annexure k.
e) Other audits
@3)*)<(0 40(B*redness Audit, Paent Sasfacon
Surveys. Monitoring of Accessibility and equity issues,
informaon exchange. These audits shall be carried
out by Rogi Kalyan Sami of the hospital.
%L<(09*: '/93</039+
Monitoring by PRI/Rogi Kalyan Samies
Service/performance evaluaon by independent
*+(963()
District Monitoring Commiees formed under NRHM
shall monitor the upgradaon of Hospitals to IPHS.
Annual Jansamvad may also be held as a mechanism of
monitoring.
Monitoring of laboratory
Internal Quality Assessment Program
External Quality Assessment Program
F(6/02 '*39<(9*96(
Computers have to be used for accurate record
maintenance and with connecvity to the District
Health Systems, State and Naonal Level.
Statuary Compliance
Hospital shall fulfil all the statuary requirements
and comply to all the regulations issued by local
bodies, state and union of India. Hospital shall
have copy of these regulations/acts. List of statuary
and regulatory compliances is given in the
Annexure VIII.
Rogi Kalyan Samies (RKS)/
A/)B3<*: '*9*+(;(9<
Commiee (HMC)
Each district hospital should have a Rogi Kalyan
Samiti/Hospital Management Committee with
involvement of PRIs and other stakeholders as per
the guidelines issued by the Government of India.
These RKS should be registered bodies with an
account for itself in the local bank. The RKS/HMC
will have authority to raise their own resources
by charging user fees and by any other means and
utilize the same for the improvement of service
rendered by the District Hospital. Regular meeting
of RKS should be ensured. Outsourcing of support
services like Laundry, Housekeeping , Waste Disposal,
Power Backup etc shall done on basis of service level
agreements which include clearly defined service
deliverables and penalty clauses if service is not
delivered.
72
Cizens Charter
Each District hospital should display prominently a
cizens charter for the district hospital indicang
the services available, user fees charged, if any, and a
grievance redressal system. Cizens Charter always
should be in local language. A modal cizens charter is
+3-(9 *) 39 Annexure I
1. Mission Statement
2. Access to services
This is a general hospital. It provides medical care to
all paents who come to hospital. Emergency services
are available 24 x 7 without any discriminaon. The
management of this hospital is responsible for ensuring
the delivery of services.
3. Standards of Services
This hospital provide quality of service on the minimum
assured services set by Indian Public Health Standards
(IPHS).
4. Your Rights in the Hospital
Right to access to all the services provided by
the Hospital
1.
CITIZENS CHARTER
e.g. OUR MOTTO SERVICE WITH SMILE
A I
Right to Informaon - including informaon
relang to your treatment
Right of making decision regarding treatment
Right for privacy and condenality
Right to religious and cultural freedom
Right for Safe and Secure Treatment
Right for grievance redressal
Right to Emergency Care
5. General Informaon
This is secondary care level mulspecialty
hospital.
This hospital has
a. ............... Beds
b. ............... Doctors
c. ................ Nurses
d. ............... Ambulances
2.
3.
4.
5.
6.
7.
8.
1.
2.
Mu|n Spec|a||ty CD Indoor 1reatment]Wards 24 hrs Lmergency Matern|ty Serv|ces
(including High Risk Pregnancy)
kad|o|ogy
(X-Ray, Ultrasound, CT-Scan)
Laboratory
(pathology, biochemistry,
microbiology)
24 nrs harmacy ICU
(Intensive Care Unit)
Nursery DC1 Center 24 nrs 8|ood 8ank Cperanon 1heatre
Iam||y |ann|ng Serv|ces Med|co|ega| and ost-mortem
Serv|ces
(Mortuary Services available)
24 nrs Ambu|ance IC1C
(Integrated Counselling and
Tesng Center)
AUSn Immun|zanon Counse|||ng Serv|ces
(Medical Social Work)
Dennstry
1e|emed|c|ne
6. Services Available
74
7. Enquiries and Informaon
Enquiry counter is located at..........................................
Timings for working counter are.....................................
Phone no. for telephonic enquiry (24 hours
service)............................................................................
Locaon guide maps and direconal signages have been
put up at strategic points in the hospital.
8. Casualty & Emergency Services
Iac|||nes
All Emergency Services are available round the
6:/68
&B(63*:3)< 2/6</0) *0( *-*3:*R:( /9 6*:: 50/;
resident doctors.
Emergency services are available for all
specialies as listed in the OPD Services.
Medico legal services are available.
Referral Services to higher centre in case
facilies for treatment are not available in the
hospital
Round the clock ambulance services with basic
life support.
In serious cases, treatment/management gets
priority over paper work like registraon and
medico-legal requirements. The decision rests
with the treang doctor.
9. OPD Services
OPD services are available on all working days excluding
Sundays and Gazeed Holidays.
Timings -
Morning ....................am to.................. am/pm
Evening .....................pm to.................. pm.
Various outpaent services available in the hospital are
detailed below (as available):
Department koom no. 1|m|ngs
>(9(0*: '(23639(
General Surgery
Obstetrics & Gynaecology
4*(23*<036)
Eye
%#$
&839 *92 P@
Department koom no. 1|m|ngs

Psychiatry
Orthopaedics
@(9<*: "4@
........................................................................................
........................................................................................
AUSn Serv|ces:
Homeopathic
Ayurvedic
Others
Med|ca| Iac|||nes Not Ava||ab|e:
Neurosurgery
...............................................................
...............................................................
...............................................................
10. Diagnosc services
List of tests available with charges are
displayed at respecve departments and
enquiry counter.
Tests are free for Below Poverty Line (BPL)
paents. Charges can be waived on showing
proof of BPL category or by wrien permission
from Deputy medical superintendent, medical
superintendent or Rogi Kalayan Sami.
I. Laboratory Services
$3;39+) -
Roune tests are done in following specialies -
Bio-chemistry
Microbiology
Haematology
Cytology
Histopathology including FNAC
Clinical Pathology
II. Radio Diagnosc Services
Departments 1|m|ngs
X-Rays
U:<0*)/?92
!7$ )6*9
!/:/0 2/B:(0
a.
b.
c.
d.
e.
f.
75
III. Cardiology Diagnoscs
%!>
%!A"
$'$
11. Indoor Paent Services
There are following wards in the hospital
Genera| ward 8ed a||ocated 8ed Ava||ab|e
'*:( '(236*:
'*:( &?0+36*:
.(;*:( '(236*:
.(;*:( &?0+36*:
Maternity Ward
Children Ward
........................................................................................
........................................................................................
........................................................................................
403-*<( N*02
........................................................................................
........................................................................................
M9<(9)3-( !*0( 1*02
M!U
&#!U
Facilies for IPD paents
All paents admied in General Wards of the
Hospital are treated free of cost.
Free diet 3 mes a day as per requirement of
the paent.
24 hour nursing services.
24 hour availability of duty doctor.
1.
2.
3.
4.
12. Complaints & Grievances
Every grievance will be duly acknowledged.
We aim to sele your genuine complaints within
......................................... days of its receipt.
Suggesons/Complaint boxes are also provided
at enquiry counter and........... in the hospital.
If we cannot, we will explain the reasons and
the me we will take to resolve.
Name, designaon and telephone number of
the nodal ocer concerned is duly displayed at
the Recepon.
Dr. ................................................
Designaon ..........................................
Tele (O) .. (R) ...................
(M)...................................................
Meeng Hours..... to .....
13. Your Responsibilies
Please do not cause inconvenience to other
paents.
Please help us in keeping the hospital and its
surroundings neat and clean.
Beware of Touts. If you nd any such person in
premises tell the hospital authories.
The Hospital is a No Smoking Zone and
smoking is a Punishable Oence.
Please cooperate with the hospital
administraon for normalizing the situaon in
case of an emergency.
Please provide useful feedback & constructed
suggesons. These may be addressed to the
Medical Superintendent of the Hospital.
The Bio-Medical Waste (Management & Handling)

Rules, 1998 were noed under the Environment
Protecon Act, 1986 (29 of 1986) by the Ministry of
Environment and Forest, Govt. Of India on 20
th
July,
1998. The guidelines have been prepared to enable each
hospital to implement the said Rules, by developing
comprehensive plan for hospital waste management,
in term of segregaon, collecon, treatment,
transportaon and disposal of the hospital waste.
Policy on Hospital Waste Management
The policy statement aims to provide for a system for
management of all potenally infecous and hazardous
waste in accordance with the Bio-Medical Waste
(Management & Handling) Rules, 1998 (BMW, 1998).
Denion of Bio-medical Waste
Bio-Medical waste means any waste, which is generated
during the diagnosis, treatment or immunisaon
of human beings or animal or in research acvies
pertaining thereto or in the producon or tesng
of biological, including categories menoned in the
Schedule of the Bio-Medical Waste (Management &
Handling) Rules, 1998.
Categories of Bio-medical Waste
Hazardous, toxic and Bio-Medical waste has been
separated into following categories for the purpose
A II A : #7$M"#7T >UM@%TM#%& "# A"&4M$7T N7&$%
MANAGEMENT BASED UPON THE BIOMEDICAL WASTE
MANAGEMENT & HANDLING RULES, 1998
of its safe transportaon to a specic site for specic
treatment. Certain categories of infecous waste require
specic treatment (disinfecon/decontaminaon)
before transportaon for disposal. These categories of
Bio-medical waste are menoned as below:
Category No. 1- Human Anatomical Waste
This includes human ssues, organs, and body parts.
Category No. 2- Animal Waste
This includes animal ssues, organs, body parts,
carcasses, bleeding parts, uid, blood and experimental
animal used in research; waste generated by veterinary
hospitals and colleges: discharge from hospital and
animal houses.
Category No. 3- Microbiology & Biotechnology
N*)<(
This includes waste from laboratory cultures, stocks
or specimens of microorganism live or aenuated
vaccines, human and animal cell culture used in research
and infecous agents from research and industrial
laboratories, wastes from producon of biological,
toxins, dishes and devices used for transfer of cultures.
Category No. 4- Waste sharps
This comprises of needles, syringes, scalpels, blades,
glass, etc., that may cause puncture and cuts. This
includes both used and unusable sharps.
A II
A"&4M$7T N7&$% '7#7>%'%#$
77
Category No. 5 - Discarded Medicines and
Cytotoxic drugs
This includes wastes comprising of outdated,
contaminated and discarded medicines.
Category No. 6- Soiled Waste
It comprises of item contaminated with blood, and
body uids including coon, dressings, soiled plaster
casts, linens, beddings, other material contaminated
with blood.
Category No. 7- Solid Waste
This includes wastes generated from disposable items,
other than the waste sharps, such as tunings, catheters,
intravenous sets, etc.
Category No. 8- Liquid Waste
This includes waste generated form laboratory and
washing, cleaning, housekeeping and disinfecng
acvies.
Category No. 9- Incineraon Ash
This consists of ash form incineraon of any Bio-medical
waste.
Category No. 10- Chemical Waste
This contains chemical used in producon of biological
and chemical used in disinfecon, inseccides, etc.
Segregaon of Waste
It should be done at the site of generaon of
Bio-medical waste, e.g., all paent care acvity
1.
areas, diagnosc services areas, operaon
theatre labour rooms, treatment rooms etc.
The responsibility of segregaon should be with
the generator of Bio-medical waste i.e. Doctors,
Nurses, Technicians, etc.
The Bio-medical waste should be segregated as
per categories applicable.
Collecon of Bio-medical Waste
Collecon of Bio-Medical Waste should be done as per
Bio-Medical Waste (Management & Handling) Rules,
1099 (Rule 6-Schedule II). The collecon bags and
the containers should be labelled as per guidelines of
Schedule III, i.e., symbols for bio-hazard and cytotoxic.
A separate container shall be placed at every pointy of
generaon for general waste to be disposed of through
Municipal Authority.
The trolleys which are used to collect hospital waste
should be designed in such a way that there should
be no leakage or spillage of Bio-medical waste while
transporng to designated site.
1ype of conta|ner and co|our for co||ecnon of
8|o-med|ca| waste:
Those plascs bags which contain liquid
like blood, urine, pus, etc., should be put
39</ 0(2 6/:/?0 R*+ 5/0 ;360/1*-39+ *92
autoclaving and other items should be
put into blue or white bag aer chemical
treatment and mulaon/shredding.
All the items sent to incinerator/deep burial
(Cat. 1, 2, 3, 6) should be placed in Yellow
coloured bags.
2.
3.
1.
2.
S|. No. Category 1ype of conta|ner Co|our Cod|ng
= A?;*9 79*</;36*: N*)<( Plasc Bag Yellow
2 793;*: N*)<( Plasc Bag Yellow
C Microbiology & Bio-Technology Waste Plasc Bag Yellow/Red
D Waste sharp Plasc bag, Puncture Proof Container Blue/White/Translucent
E Discarded Medicines & Cytotoxic Waste Plasc Bag Black
H Solid waste (plasc) Plasc Bag Yellow/Red
J Solid Waste( Plasc) Plasc Bag Blue/White
I T3G?32 1*)<( --------- --------
O Incineraon ash Plasc Bag Black
=K Chemical waste(solid) Plasc Bag Black
78
All the Bio-medical waste to be sent for
Microwave/Autoclave treatment should be
placed in Red coloured bags. (Cat. 3, 6 &)
Any waste which is sent to shredder aer
Autoclaving/Microwaving/Chemical treatment
is to be packed in Blue/White translucent bag.
Locanon of Conta|ners: All containers having
dierent coloured plasc bags should be located
at the point of generaon waste, i.e., near
OT tables, injecon rooms, diagnosc service
areas, dressing trolleys, injecon trolleys, etc.
Labe|||ng: All the bags/containers must
be labelled bio-hazard or cytotoxic with
symbols according to the rules (Schedule III of
Bio-Medical Waste Rules, 1998).
8ags: It should be ensured that waste bags are
lled up to three-fourth capacity, ed securely
and removed from the site of the generaon to
the storage area regularly and mely.
The categories of waste (Cat. 4, 7, 8, & 10) which
require pre-treatment (decontaminaon/
disinfecon) at the site of generaon such as
plasc and sharp materials, etc. should be
removed from the site of generaon only aer
pre-treatment.
The quanty of collecon should be documented
in a register. The colour plasc bags should be
replaced and the garbage bin should be cleaned
with disinfectant regularly.
&</0*+( /5 N*)<(
Storage refers to the holding of Bio-medical waste for
a certain period of me at the site of generaon ll its
transit for treatment and nal disposal.
No untreated Bio-medical waste shall be kept
stored beyond a period of 48 hours.
The authorised person must take the permission
of the prescribed authority, if for any reason it
becomes necessary to store the waste beyond
48 hours.
The authorised person should take measures to
ensure that the waste does not adversely aect
human health and the environment in case it is
kept beyond the prescribed limit.
Transportaon
Transportaon of Waste Within The Hospitals:
Within the hospital, waste routed must
be designated to avoid the passage of
3.
4.
5.
6.
7.
8.
9.
1.
2.
3.
1.
a.
waste through paent care areas as far as
possible.
Separate me schedules are prepared for
transportaon of Bio-medical waste and
general waste. It will reduce chances of
their mix up.
Dedicated wheeled containers, trolleys or
carts with proper label (as per Schedule IV
of Rule 6) should be used to transport the
waste from the site of storage to the site of
treatment.
Trolleys or carts should be thoroughly
cleansed and disinfected in the event of
any spillage.
The wheeled containers should be designed
in such a manner that the waste can be
easily loaded, remains secured during
transportaon, does not have any sharp
edges and easy to cleanse and disinfect.
Transportaon of Waste for Disposal Outside
The Hospital.
Notwithstanding anything contained in
the Motor Vehicles Act, 1988 or rules
there under. Bio-medical waste shall be
transported only in such vehicles as may
be authorised for the purpose by the
Competent Authority.
The containers for transportaon must be
labelled as given in Schedule III and IV of
BMW, 1998.
Treatment of Hospital Waste (Please see
Rule 5. Schedule V & VI)
Genera| waste (Non-hazardous, non-toxic,
non-infecous). The safe disposal of this waste
should be ensured by the occupier through
Local Municipal Authority.
8|o-Med|ca| Waste
'/93</039+ /5 39639(0*</0V*?</6:*-(V;360/1*-(
shall be carried out once in a month to check
the performance of the equipment. One should
ensure:
The proper operaon & Maintenance of
the incinerators/autoclave/microwave.
Aainment of prescribed temperatures in
both the chambers of incineraon while
incinerang the waste.
Not to incinerate PVC plasc materials.
b.
c.
d.
e.
2.
a.
b.
1.
2.
a.
b.
c.
79
Only skilled persons operate the
equipment.
Proper record book shall be maintained
for the incinerator/autoclave/microwave/
shredder. Such record book shall have the
entries of period of operaon, temperature/
pressure aained while treang the waste
quanty for waste treated etc.
The scavengers shall not be allowed to sort
out the waste.
Proper hygiene shall be maintained at,
both, the waste treatment plant site as well
as the waste storage area.
Categories 4, 7, 8 & 10 should be
treated with chemical disinfectant like
1% hypochlorite soluon or any other
equivalent chemical reagent to ensure
disinfecon.
Inc|neranon: The incinerator should be
installed and made operaonal as per
specicaons under the BMW Rules, 1998
(schedule V) and an authorizaon shall
be taken from the prescribed authority
for the management and handling of Bio-
medical waste including installaon and
operaon of treatment facility as per Rule
8 of Bio-Medical Waste (Management &
Handling) Rules 1998. Specic requirement
regarding the incinerator and norms of
combuson eciency and emission levels
etc. have been dened in the Bio-Medical
Waste (Management & Handling) Rules
1998. In case of small hospitals, Joint
facilies for incineraon can be developed
depending upon the local policies of the
Hospital and feasibility. The plasc Bags
made of Chlorinated plascs should not be
incinerated.
Deep bur|a|: &<*92*02 5/0 2((B R?03*: *0(
also menoned in the Bio-medical waste
(Management & handling) Rules 1998
(Schedule V). The cies having less than
5 lakhs populaon can opt for deep burial
for wastes under categories 1 & 2.
Autoc|ave and M|crowave 1reatment:
Standards for the autoclaving and
Microwaving are also menoned in the
Bio-medical Waste (Management &
d.
e.
f.
g.
h.
Handling) Rules 1998 (Schedule-V). All
equipment installed/shared should meet
these specicaons. The waste under
category 3, 4, 6 & 7 can be treated by these
techniques.
Shredd|ng: The plascs (IV bole IV sets
syringes, catheters, etc.) sharps (needles,
blades, glass, etc.) should be shredded but
only aer chemical treatment/Microwaving/
Autoclaving, ensuring disinfecon.
Needles destroyers can be used for disposal
of needles directly without chemical
treatment.
Secured |and||: The incinerator ash,
discarded medicines, cytotoxic substances
and solid chemical waste should be treated
by this opon (cat. 5,9 & 10).
It may be noted there are mulple opons
available for disposal of certain category of
waste. The individual hospital can choose
the best opon depending upon treatment
facilies available.
kad|oacnve Waste: The management of
the radioacve waste should be undertaken
as per the guidelines of BARC.
L|qu|d (Cat. 8) & Chem|ca| Waste (Cat. 10):
Chemical waste & liquid waste from
Laboratory: Suitable treatment, diluon
or 1% hypochlorite soluon as required
shall be given before disposal.
The auent generated from the hospital
should conform to limits as laid down in
the Bio-medical Waste (Management &
Handling) Rules, 1998 (Schedule V).
The liquid and chemical waste should
not be used for any other purpose.
For discharge into public sewers with
terminal facilies the prescribed
standard limits should be ensured.
Safety Measures
Personal Protecon
Hospital and health care authories have to ensure
that the following personal protecve equipment are
provided.
i.
ii.
iii.
iv.
80
>:/-()
@3)B/)*R:( +:/-()
T*<(L )?0+36*: +:/-()
Heavy duty rubber gloves (upl elbows) for
cleaners.
Masks: Simple and cheap mask to prevent
health care workers against: aerosols splashes
and dust.
Protecve glasses.
Plasc Aprons.
Special Foot wear, e.g., gum boots for Hospital
waste Handler.
Immunizaon against Hepas B and Tetanus shall be
given to all hospital sta.
All the generators of Bio-medical waste should adopt
universal precauons and appropriate safety measures
while doing therapeuc and diagnosc acvies and
also while handling the Bio-Medical waste.
All the sanitaon workers engaged in the handling and
transporng should be made aware of the risks involved
in handling the Bio-medical waste.
Any worker reporng with an accident/injury due to
handling of biomedical waste should be given prompt
rst aid. Necessary invesgaons and follow up acon
as per requirement may be carried out.
Reporng Accident & Spillages
The procedure for reporng accidents (as per Form III of
BMW Rules. 1998) should be followed and the records
should be kept. The report should include the nature
of accidents, when and where it occurred and which
stas were directly involved. It should also show type of
waste involved and emergency measures taken.
$0*3939+
All the medical professional must be made
aware of Bio-medical waste (Management &
Handling) Rules, 1998.
Each and every hospital must have well planned
*1*0(9()) *92 <0*3939+ B0/+0*;;( 5/0 *::
1.
a.
b.
c.
2.
3.
4.
5.
1.
2.
6*<(+/03() /5 B(0)/99(: 396:?239+ *2;393)<0*</0)
to make them aware about safe hospital waste
management pracces.
Training should be conducted category wise
and more emphasis should be given in training
modules as per category of personnel.
Training should be conducted in appropriate
:*9+?*+(V;(23?; *92 39 *9 *66(B<*R:(
manner.
Wherever possible audio-visual material and
experienced trainers should be used. Hand on
training about colour coded bags, categorizaon
and chemical disinfecons can be given to
concerned employees.
$raining should be interacve and should
include, demonstraon sessions, Behavioural
science approach should be adopted with
emphasis on establishing proper pracces.
Training is a connuous process and will need
constant reinforcement.
Management & Administraon
The Head of the Hospital shall form a
waste Management Commiee under his
Chairmanship. The Waste Management
Commiee shall meet regularly to review
the performance of the waste disposal. This
Commiee should be responsible for making
hospital specic acon plan for hospital waste
management and for its supervision, monitoring
implementaon and looking aer the safety of
the bio-medical waste handlers.
The Heads of each hospital will have to take
authorizaon for generaon of waste from
appropriate authories well in me as noed
by the concerned State/U.T. Government and
get it renewed as per me schedule laid in
the rules. The applicaon is to be made as per
format given in form I for grant of authorizaon.
(Please See page 18 of noes BMW Rules).
The annual reports accident reporng, as
required under BMW rules should be submied
to the concerned authories as per BMW
rules format (Form II and Form III respecvely)
(Please see pages 19 & 20 of BMW Rules).
3.
4.
5.
6.
1.
2.
3.
1. Following guidelines will be used for management
of Mercury waste:
As mercury waste is a hazardous waste, the
storage, handling, treatment and disposal
pracces should be in line with the requirements
of Government of Indias Hazardous Waste
(Management, Handling and Trans-boundary
Movement) Rules 2008, which may be seen at
website www.cpcb.nic.in.
Mercury-contaminated waste should not be
mixed with other biomedical waste or with
general waste. It should not be swept down
the drain and wherever possible, it should be
disposed o at a hazardous waste facility or given
to a mercury-based equipment manufacturer.
Precauon should be taken not to handle
mercury with bare hands and as far as possible;
jewellery should be removed at the me of
handling mercury. Aer handling mercury,
hands must be carefully washed before eang
or drinking. Appropriate personal protecve
equipment (rubber gloves, goggles/face
a.
b.
c.
shields and clothing) should be used while
handling mercury.
Mercury-containing thermometers should be
kept in a container that does not have a hard
boom. Prefer a plasc container to a glass
container, as the possibility of breakage will be
less.
In case of breakage, cardboard sheets should
be used to push the spilled beads of mercury
together. A syringe should be used to suck the
beads of mercury. Mercury should be placed
carefully in a container with some water. Any
remaining beads of mercury will be picked up
with a scky tape and placed in a plasc bag,
properly labeled.
2. Reporng formats must be used to report and
register any mercury spills/leakages.
3. Hospitals and health centres should work to
create awareness among health workers and other
stakeholders regarding the health and safety hazards
of mercury.
d.
e.
A II B : >UM@%TM#%& $" F%@U!% %#PMF"#'%#$7T
POLLUTION DUE TO MERCURY WASTE
Infecon control measures include Work pracces and
other measures designed to prevent transmission of
infecous agents. These infecons generally occur
Paent to paent
Paent to Health Care Worker (HCW)
HCW to Paent
A!N </ A!N
P3)3</0)
The possible source of air borne infecons are i.e.
3. Ins|de fac|||ty (paent Health Care Worker, visitors
infected dust and aerosols venlaons and air-
condioning system.
ii. Cuts|de the fac|||ty such as construcon and
renovaon, cooling towers, soil etc.
The fundamental of infecon control depends on
the various measures of controlling, in which
hierarchy is:
Administrave control
%9-30/9;(9<*: 6/9<0/:
Respiratory protecon measures
Hence the Frame work and appropriate strategy are:
Primarily prevenon of exposures - Contro| at
the source (administrave control).
If cannot be achieved then exposures should be
0(2?6(2 a|ong the path (Environmental Control
i.e., venlaon protecon barriers related
measures).
1.
2.
3.
4.
5.
a.
b.
As a last, exposures should be controlled at
the |eve| of the person (personal protecon
equipment).
Lnv|ronmenta| Contro| ;(*)?0() *0(
1. The nVAC (Heang Venlaon & Air condioning)
system.
2. |ann|ng parameters on the health care buildings:
In the planning parameter the rst important feature
3) 2on|ng in which the usage of area are idened
and put in a proper zone in terms of revennve
2one /0 Curanve 2one and also the C|ean 2one *92
D|rty Un||ty 2one.
The funconal planning is done with segregaons of
trac ow in terms of:
Paent
Doctors/Para Medical Sta
'/-(;(9< /5 ;*<(03*:
P3)3</0)
Locaon of sinks and dispenser in hand
washing.
Convenient locaon of soiled ulity area.
Locaon of adequate storage and supply area.
Isolated rooms with anterooms as appropriate.
Properly engineered areas for linen services
and solid waste management.
Air handling system engineered for opmal
performance, easy maintenance and repair.
c.
GUIDELINES FOR AIR BORNE

M#.%!$M"# !"#$F"T
A III
83
U)( /5 (9-30/9;(9<*: 6/9<0/: ;(*)?0() 3) </ B0(-(9<
the spread and reduce the concentraon of infecous
droplet nuclei in ambient air. The environmental control
is divided into:
r|mary env|ronmenta| contro| 6/9)3)<) /5
controlling the source of infecon by using
local exhaust venlaons e.g., hoods etc. and
dilung and removing contaminated air by
using general venlaons.
Secondary venn|anon contro| 6/9)3)<)
of controlling the air ow to prevent
contaminaons of air in areas adjacent to
the source and cleaning the air by using High
Eciency Parculates Air (HEPA) ltraon, UVGI
(ultra violet Germicidal Irradiaon). Moisture
related HVAC component such as cooling coil
humidicaon system should be properly
maintained as they are one of the sources of
contaminants and cause adverse health eects
in occupants.
Indoor A|r ua||ty (IA) is depending upon three major
factors:
arncu|ates: Such as dust, dander, pollen,
organic clumps which are usually handled by
air ltraons. Hence lter must be maintained
eecvely.
M|crob|a|: Bacteria, virus, mold spores.
a.
b.
Gases
VOC (Volale Organic Compound) which are
found in smoke, carpets, cleaning agents,
paint, new construcon, pressed wood
products which can cause eye, nose, throat
irritaon, headache nausea etc.
"2/?0) caused by odorant molecules dissolved
in the air i.e., food odor perfume etc.
1he precaunons to prevent a|r borne |nfecnons, to be
fo||owed are:
Private room with monitored neganve a|r
pressure.
6 to 12 a|r changes per hour in HVAC System
Use of High Eciency parculates Air (nLA)
|ter for re-circulated air.
However, it is found that lters are great for
trapping micro-organism but they do not kill. If
not properly maintained, eventually the lters
can become colonized and act as a breeding
ground for pathogens.
The use of UVGI in air -condioned building: as
UVGI deacvates bacteria, fungi and viruses on
surface as well as in the air. This is exible and can
be installed in any new and exisng HVAC system.
HCW respirators (minimum N 95).
Limited paent movement/transportaon for
essenal purpose only.
c.
i.
ii.
i.
ii.
iii.
iv.
v.
vi.
STEPS FOR SAFETY IN SURGICAL PATIENTS
A IV
1o be done by Surgeon
History, examinaon and
invesgaons
Pre-op orders
Check and reconrm PAC ndings.
Assess and menon any
co-morbid condion.
Record boldly on 1
)<
B*+( /5 6*)(
sheet --
--History of drug allergies.
Blood transfusion
- Sample for grouping and cross-
matching to be sent.
- Check availability & donaon
- Risk of transfusion to be
explained to relaves
Wrien well informed consent
from paent
(Counter sign by surgeon)
Sister in charge of O. T. to be
informed in advance regarding the
need for special equipment.
S|gnature of Surgeon
1o be done by Sta Nurse
Paents consent to be taken
(Counter sign by surgeon)
Part preparaon as ordered
Idencaon tag on paent wrist
Name/Age/Sex/C.R. No/
&?0+36*: ?93<V@3*+9/)3)
Follow pre-op orders
Anbioc sensivity test done
S|gnature of Sta Nurse
1o be done by Anesthenst
Check PAC ndings
Assess co morbid condions
H/O any drug allergy
Check Consent
S|gnature of Anaesthenst
Steps for safety in surgical paents (in the pre-operave ward)
85
S|gn In (Period before inducon of
anesthesia)
anent has conrmed
Identy
&3<(
40/6(2?0(
!/9)(9<
S|te marked]Not App||cab|e
Anesthesia Safety Check
!/;B:(<(2
Anesthesia Equipment
A B C D E
Pulse Oxymeter on Paent and
funconing
DCLS A1ILN1 nAVL A:
known A||ergy
#/
Yes
D|cu|t A|rway]Asp|ranon k|sk?
#/
Yes, and assistance available
k|sk of >S00 m| 8|ood |oss (7 m|]kg |n
ch||dren)
#/
Yes and adequate I. V. access
& Blood/Fluids Planned.
S|gnature of Nurse
1|me Cut (Period aer inducon &

before surgical incision)
Conrm a|| team members have
|ntroduced themse|ves by name
& ro|e
Surgeon, Anesthenst & Nurse
verba||y Conrm
Paent
&3<(
40/6(2?0(
AN1ICIA1LD CkI1ICAL LVLN1S
Surgeons rev|ews: What are
the crical or unexpected steps,
operave duraon & ancipated
R://2 :/))
Anesthenst rev|ews: Are there
any paent specic concerns
Nurs|ng 1eam rev|ews: A*)
sterility been conrmed? Is there
equipment issue or any concern?
nas Annb|onc prophy|ax|s been g|ven
w|th |n the |ast 60 m|nutes?
Yes
#/< 7BB:36*R:(
Is Lssenna| Imag|ng D|sp|ayed?
Yes
#/< 7BB:36*R:(
S|gnature of Surgeon
S|gn Cut (Period from wound closure

ll transfer of paent from OT room)
Nurse Verba||y conrm w|th the team:
The name of the procedure
0(6/02(2
1hat |nstrument, sponge, need|e
counts are correct (or not
applicable)
now the spec|men |s |abe|ed
(including Paent name)
Whether there are any
equ|pment prob|ems to be
addressed?
Surgeon, Anesthenst & Nurse
rev|ew the key concerns for
recovery and management of
panent & post- op orders to be
g|ven accord|ng|y
Informanon to panents auendant
about procedure performed,
condion of the paent &
specimen to be shown
n|stopatho|ogy formto be lled
properly & return a|| the 0(6/02)
& |nvesnganon to aendant/
paent
S|gnature of Anaesthenst
Surgical safety check list in the operaon theatre
REFERRAL LABORATORY NETWORKS
A V
Referral Laboratory Network for Advanced diagnosc facilies
IDS Leve| - 4 Labs IDS Leve| S
Labs
Centra| 2one South 2one North 2one Last 2one West 2one
Advance Diagnosc Facilies
8acter|a| d|agnos|s
Enteric bacteria: "#$%#&
'(&)*%+*, -(#.*))+,
-+)/&0*))+
!'! P(::/0(
$03-*920?;
'(236*:
!/::(+(
4>M'%F
Chandigarh
AIIMS Delhi
!FM S*)*?:3
F'F!
Dibrugarh,
Cuack Medical
!/::(+(
S%'
Mumbai,
7.'! 4?9(
NICED & NICD
-1%*21&'&''34
25&.*0*4 *92
- 20*3/&0#+*
M92/0(
'(236*:
!/::(+(
St. John
'(236*:
College,
Bangalore
VP. Chest
University of
Delhi
BJ MC !'! P(::/0(
67 8#2(1(*%#+* BHU CMC, Vellore NICD, Delhi STM, Kolkata AFMC, Pune VP Chest
Instute, Delhi
Neisseria meningidIs
*92 97 .&0&%%(*+*
&# '(236*:
College, Agra
&<*<( 4A T*R
$03-*920?;
4>M'%F
Chandigarh
&?0*<
'(236*:
!/::(+(
!'! P(::/0(
& PGIMER
Chandigarh
-1+2(5)&'&''34 BHU '>F '(236*:
University
'*?:*9*
Azad Medical
College,
Delhi
STM, Kolkata AFMC, Pune NICD, Delhi
$?R(06?:/)3) State TB Demonstraon & Training Centre (for all zones) ICGEB, Delhi NTI, TRC
T(B</)B30/)3) @F@% Virology
Instute,
Allepey
$*;3: #*2?
University,
Chennai VCRC,
Pondicherry
7MM'&
MPFM
RMRC,
Bubaneswar &
Dibrugarh
BJMC RMRC Port Blair
87
Labs
P30*: @3*+9/)3)
%9<(036 -30?)() @F@% CMC, Vellore AIIMS &
P3::?B?0*;
Chest
Instute
#M!%@ S/:8*<* EVRC, Mumbai,
NIV & NICD
70R/-30?)() @F@% CMC, Vellore AIIMS &
NICD Delhi
Chest
Instute
#M!%@ S/:8*<* #MP
Myxoviruses @F@% CMC, Vellore AIIMS &
NICD Delhi
Chest
Instute
#M!%@ S/:8*<* NIV, HSADL
Bhopal
Hepas viruses @F@% CMC, Vellore 7MM'&
ICGEB, Delhi
#M!%@ S/:8*<* #MP
#(?0/<0/B36 -30?)() @F@% CMC, Vellore AIIMS &
NICD Delhi
#MP #M'A7#&
AMP @F@% CMC, Vellore 7MM'& NARI, NICD &
#7!"
ICGEB, Delhi
aras|nc D|agnos|s
'*:*03* All State Public Health Laboratories MRC, Delhi
ICGEB, Delhi
.3:*03* All State Public Health Laboratories NVBDCP,
Delhi VCRC
Pondicherry
Zoonoses
@(9+?( @F@% VCRC,
Pondicherry
Instute of
Virology,
Aleppey
7MM'& #M!%@ #MP #MP
ICGEB, Delhi
JE @F@% CRME,
Madurai &
#M'A7#&
VCRC,
Pondicherry
7MM'& #M!%@ #MP #MPV#M!@
4:*+?( @F@% #M!@
Bangalore
NICD, Delhi - Hakins
Instute
NICD, Delhi
Rickesial diseases @F@% CMC, Vellore - - 7.'! #M!@
MPFM
Others of Public Health Importance
Anthrax @F@% CMC, Vellore IGIB NICED, Calcua BJMC #M!@
MPFM
88
Labs
'360/R3*: 1*<(0
quality monitoring
NEERI, Nagpur CMC Vellore,
$03-*920?;
'(236*:
!/::(+(
4>M'%F
Chandigarh
AIIMS Delhi
!FM S*)*?:3
RMRC,
Dibrugarh,
Cuack Medical
!/::(+(
S%'
Mumbai,
HAFFKINs,
'?;R*3
7.'! 4?9(
NICED & NICD
Unknown pathogens Other laboratories to perform support funcons NIV, NICD,
A&7@T
Outbreak invesgaon
)?BB/0<
Medical Colleges and state public health laboratories as L3/L4 NICD, NIV,
NICED, VCRC
Laboratory data
;*9*+(;(9<
Medical Colleges, state public health laboratories and all the L4 & L5
laboratories (in their area of experse)
NIV, NICD
Capacity building All the L4 & L5 laboratories (in their area of experse) NIV, NICD
Quality assurance All the L4 & L5 laboratories (in their area of experse) CMC, TRC, NTI,
AFMC, NARI,
RMRC,Port Blair
NIV, NICD
Quality control of
reagents & kits
evaluaon
All the L4 & L5 laboratories (in their area of experse) CMC, TRC, NARI,
RMRC, Port
Blair NIV, NICD,
BJMC, NICED
Producon & supply
/5 0(*+(9<)V83<)V
R3/:/+36*:V)<*92*02
0(5(0(96( ;*<(03*:)
- DRDE, NIV, IVRI,
NICED, NICD,
MRC,Delhi
AFMC, Pune
#7FM
TRC, Chennai
RMRC, Port
Blair
Biosafety &
Bio-containment
Other laboratories to perform support funcon HSADL,
NIV/MCC,
DRDE,
#M!@
The SNCU at the district hospital is expected to provide
the following services:
Care at birth
Resuscitaon of asphyxiated newborns.
Managing sick newborns (except those
requiring mechanical venlaon and major
surgical intervenons).
Kangaroo mother care.
Post natal care.
Follow-up of high risk newborns.
Referral services.
Immunizaon services.
>(9(036 4:*9 ./0 @3)<036< T(-(: &B(63*:
Newborn Care Units (Level II)
Special Newborn Care Units (SNCU) are a special
newborn unit meant primarily to reduce the case fatality
among sick children born within the hospital or outside,
including home deliveries within rst 28 days of life.
These units will have
Ma|n Spec|a| Newborn Care Un|t: This should
have at least 12 beds, which would cater to the
sickest child in the Hospital. It will have space
for nursing work staon, Hand Washing and
Gowning at the point of entry.
Step Down Un|t Ior Ch||dren: This is an
addional 6 bed Step down Unit where
recovering neonates can stay i.e. neonates who
dont need intensive monitoring.
1.
2.
3.
4.
5.
6.
7.
8.
1.
2.
SPECIAL NEWBORN CARE UNIT SNCU AT
@M&$FM!$ A"&4M$7T
A VI
Spec|a| Newborn Care Ward: This is an
addional 10 beds, where both the mother and
the newborn can stay together for neonates
who require minimal support such as for
phototherapy, uncomplicated low birth weight
for observaon esp. weighing more than
1800 gm and supercial infecons etc.
Io||ow up area: This should be an addional
area outside but not far away from the SNCU.
This should be designated for follow up of the
neonates discharged from the SNCU.
Newborn corner w|th fac|||nes for neonata|
warmer and resusc|tanon at the |abor room
and Cbstetr|cs Cperanon 1heatre #$%&''()*
()+(.
S|de Laboratory koom with facilies for at least
doing neonatal sepc screen and measuring
R3:30?R39 :(-(:.
1each|ng and 1ra|n|ng koom.
Day and N|ght She|ter for mothers of out born
neonates with I.E.C. facilies e.g., T.V. with
Audio- Video facilies.
Place for In-house facility for wash|ng, dry|ng
and autoc|av|ng.
Duty koom for doctors and Nurses.
4:*6( 5/0 romonon of 8reast feed|ng and
|earn|ng mother crah.
4:*6( 5/0 So||ed Un||ty]no|d|ng koom and
C|ean Un||ty]no|d|ng Area (s).
Ma|n Spec|a| Newborn Care Un|t: &B(63*: #(1R/09
Care Units (SNCU) should be ideally established in a
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
90
facility in a resource poor area where not less than 1000
deliveries occur per year.
The SNCU should have at least 12 beds providing
24 hours service.
Locaon of the SNCU
Should be located near the Labour Room, Labour
Ward and Obstetrics Operaon Theatre.
Should not be located on the top oor.
Should be accessible from the main entrance of
the hospital.
&B*6( 0(G?30(;(9<
Minimum space requirement for each bed area is
100 sq.. This would be divided as follows:
50 sq. per bed would be for individual paent
care area.
50 sq. per bed would be for ancillary area.
Paent Care Area
SNCU Ma|n Area: The main SNCU area should be
divided into two interconnected rooms (600 sq.ft for
each) separated by transparent observation windows.
The nursing station (200 sq.ft.) should be in between
the two rooms. This would facilitate temporary
closure of one section for disinfection. A couple of
R(2) 6*9 R( )(B*0*<(2 5/0 R*003(0 9?0)39+ /5 395(6<(2
neonates.
Apart from this there should be two rooms designated
for a Step -Down Unit and a Special Care Baby Unit
(SCBU) i.e. the Mother& Child Care Unit.
Step Down Un|t: This is an addional 6-10 bed Step Down
Unit where recovering neonates can stay i.e., neonates
who dont need intensive monitoring. This would be of
added advantage to the SNCU as it would relieve the
pressure to some extent. The space requirement would
be 50 sq.. per bed.
Spec|a| Newborn Care Ward: This is an addional
10 beds , where both the mother and the newborn
can stay together for neonates who require minimal
support such as for phototherapy , uncomplicated low
birth weight for observaon
,-''-. /0 ()+(: This should be an addional area
outside but not far away from the SNCU. This should
be designated for follow up of the neonates discharged
from the SNCU.
1each|ng koom: The SNCU also serves as a teaching

and hands-on-training centre for the enre district.
Thus with every unit there should be a room alloed
for teaching and training. This space can also be ulized
for paent party meengs. The departmental library
can be set up in this place.
Ancillary Area
The ancillary area should include separate areas for:
Hand washing and gowning area within the
'*39 &#!U
Changing Room within the Main SNCU
Nursing Work Staon within the Main SNCU
Fluid preparaon area within the Main SNCU
Space for X-ray within the main SNCU unit
Store Room for the Unit
Side Laboratory
Breast feeding room/area cum learning mother
cra
Doctors Room
Nurses Room
Washing, Drying and Autoclave Rooms
Teaching and training Room
Out born mothers Room
Sister-in-charges Room
S|u|ce koom: Place for Soiled Ulity/Holding
Room. The venlaon system in the soiled
ulity/holding room shall be engineered to have
negave air pressure with air 100% exhausted
to the outside. The soiled ulity/holding room
shall be situated to allow removal of soiled
materials without passing through the infant
care area.
Clean Ulity/Holding Area(s): For storage
of supplies frequently used in the care of
newborns.
Minimum space requirement for each room
Main SNCU 1200 sq.. (for 12 bed unit)
Step Down Unit -300 sq.. (for 6 bed unit)
Special Care Baby Unit-500 sq.. (for 6 bed unit)
Side laboratory-100 sq..
Store Room-100 sq..
Washing, Drying and Autoclave room-150 sq..
(there should be 3 divisions for the 3 funcons).

91
Nurses work Staon-100 sq..
Shelter for out born mothers-250 sq..
Nurses Room-100 sq..
Doctors Room -100 sq..
Teaching and Training Room-400 sq..
Sister-in-charges Room-50 sq..
Room for breast feeding and learning mother
cra-100 sq..
Soiled Ulity/Holding Room -50 sq..
Clean Ulity/Holding Area 50 sq..
Total space required = 3550 sq..
Specicaons
N392/1)
Should be easily cleaned
Should be there as a source of natural light
Should be made of xed glass with sliding
opaque glass shades (to provide shades as an
when required).
Should be at least 2 feet away from the cots.
N*::)
Should be made of washable les
The colour of the les should be white or o-
white
Yellow and blue les should not be used at all.
Tiles should be given up to 7 .
.://0
!:(*939+
Infecon control is crucial in the SNCU, so a ooring
material for paent care areas should be such that
can be easily cleaned and is essenal requirement.

Stain resistance is an important aspect for ooring that
will be used where spills of blood, iodine-containing
compounds, or other such materials are common.
kubber: Rubber ooring is the most rapidly growing
choice in newly constructed SNCUs due to its ease
of cleaning and highly durable nature. It should be
latex-free:
Other choice could be made of vitried les,
but should be of white/o-white color.
Others: These include epoxy, laminates, stone/
granite/marble, concrete, porcelain and ceramic
le, and resilient urethane.
Power supply
24 hour uninterrupted stabilized power supply
with 3 phases, capacity of 25-50 KVA.
Capable of taking up addional load.
Generator back-up essenal with 25-50 KVA
capacity.
Water Supply
1he |dea| number of Hand washing facilies should be
such that it should be within 20 (6 m) of any infant
bed, apart from the entrance to SNCU.
Should have 24 hrs uninterrupted running
water supply.
There should be wash basins with elbow/foot
operated tap in the:
Washing and gowning area (at least 2)
Main SNCU (4 in 4 corners of the room)
Step Down Unit (2 corners of the room)
There should be wash basins in the (Crd|nary
type):
Laboratory
$/3:(<)
&:?36( F//;
I|oor|ng type In|na| cost Durab|||ty Comfort]sound

contro|
Lnv|ronmenta|
|mpact
Ma|ntenance
cost
Suggested use |n
T39/:(?; T/1 '(23?; 4//0 >//2 '(23?; Supply areas
Vinyl T/1 '(23?; 4//0 .*30 '(23?; Supply areas
Cushioned Vinyl T/1 '(23?; .*30 .*30 '(23?; #/9(
!*0B(< '(23?; T/1 >//2 >//2 High 4?R:36 *0(*)
F?RR(0 High High >//2 Very good T/1 Paent care areas
Table: Summary of Flooring consideraons
92
nand wash|ng s|nk spec|canon: They shall be large
enough to control splashing and designed to avoid
standing or retained water. Minimum dimensions for
a hand washing sink are 24 inches wide 16 inches
50/9< </ R*68 10 inches deep (61 D= 25 cm
C
) from
the boom of the sink to the top of its rim. Space for
pictorial hand washing instrucons shall be provided
above all sinks. Walls adjacent to hand washing sinks
shall be constructed of nonporous material. Space shall
*:)/ R( B0/-32(2 5/0 )/*B *92 </1(: 23)B(9)(0) *92
for appropriate trash receptacles. Nonabsorbent wall
material should be used around sinks to prevent the
growth of mold on cellulose material.
L|ectr|c|ty Cut|et for |nd|v|dua| beds: 6-8 central
voltage stabilized outlets would have combined 5 and
15 amperes or at least 50% should be 5 and 50% should
be 15 (to handle all equipment).
Addional point for portable X-Ray.
Illuminaon inside SNCU
Well Illuminated but adjustable day & night to
suit the need of the baby.
Adequate day light for natural illuminaon for
examinaon of color.
Cool white uorescent tubes or CFL unit with
reecon grid providing 10-20 candle shadow
free light.
Illuminaon at the level of Neonates
Avoid exposure of the infant to direct ambient lighng.
Direct ambient light has a negave eect on the
development of the infants visual neural architecture
and early exposure to direct light may adversely aect
the development of other neurosensory systems.
Goals were to avoid direct infant lighng exposure:

Ambient lighng levels in infant spaces shall be
adjustable through a range of at least 50 to no
more than 600 lux (approximately 5 to 60 foot
candles), as measured at each bedside.
Both natural and electric light sources shall have
controls that allow immediate darkening of any
bed posion sucient for transilluminaon
when necessary.
Night illuminaon 0.5 candle at Neonates
level.
Reinforced light 100-150 candle shadow free
illuminaon for examinaon.
Venlaon
Well-venlated with fresh air: Ideally by laminar
air ow system.
By central air-condioning with Millipore lters
and fresh air exchange of 12/hour.
$(;B(0*<?0( 39)32( &#!U
To be maintained at 28 C +/- 2 C round the clock
preferably by thermostac Control.
The temperature inside SNCU should be set at
the level of comfort (22 25C).
For the sta so that they can work for long hours, by air
condioning provided the neonates are kept warm by
warming devices.
Acousc Characteriscs
Background sound should not be more than
45 db.
Peak intensity should not be more than 80 db.

93
Legends: A: AuLoclave, AC: SpllL Alr condluoner, 8: Washlng Machlne, C: CompuLer, CA: Changlng area, u1: urugs 1rolley, L: Maln
LnLrance, 8: 8efrlgeraLor, 8W: 8adlanL Warmer, SC: SLorage cablneL, W: Weghlng scale, W8: Wash 8asln W: Wlndow, WS: Work
sLauon, vlewlng wlndow: uocLors' omce cum 1eachlng 8oom and SLep-uown unlLs are locaLed on opposlLe slde of Lhe corrldor.
CC88luC8
CA 8W
8W
8W
8W 8W
8W 8W
8W 8W
8W
8W
8W
SC SC
W
8 A
AC AC W8C W8C
12 leeL
2S
leel
4
.

l
a
n

f
o
r

1
2
-
b
e
d

S
l
c
k

n
e
w
b
o
r
n

C
a
r
e

u
n
l
L

a
L

u
r
u
l
l
a

u
l
s
L
r
l
c
L

P
o
s
p
l
L
a
l
lan for CuLborn Slck newborn Care unlL, ulsLrlcL PosplLal, urulla
(noL Lo Scale)
Avallable auenL Care Area: 300 sq f Approx Ancllllary Area: sq f Approx
1S leeL 12 leeL
W W
u
1
W
S
C
W
S
u
1
8
S
S
l
d
e
L
a
b
o
r
L
a
b
l
e
x
-
8
a
y
m
a
c
h
l
n
e
L
W
S
Item No Item Descr|pnon
L
s
s
e
n
n
a
|
D
e
s
|
r
a
b
|
e
uannty for
12 bed un|t
I
n
s
t
a
|
|
a
n
o
n
1
r
a
|
n
|
n
g
C
|
v
|
|
M
e
c
h
a
n
|
c
a
|
L
|
e
c
t
r
|
c
a
|
= Open care system: radiant warmer, xed height, with
trolley, drawers, O
2
-boles
% 2 Q Q Q Q Q
2 Open care system: radiant warmer, xed height,
with trolley
% H Q Q Q Q
C Infant meter, plexi, 3 /105 cm @ = Q Q
A/1 </ 0(*2 * <*R:(
Manpower Requirement for a 12 Bed
&B(63*: #(1R/09 !*0( U93<
@/6</0)
The medical ocers must have a special
qualicaons &/or training &/or experience in
sick newborn care in a level II SNCU.
They should devout long hours for the unit or
have full me involvement.
They are primarily responsible for the complete

care of sick neonates admied in the SNCU,
Step Down Unit and Special Care Baby Unit.
They should also cover the neonates beyond
SNCU e.g. resuscitaon call for dicult
deliveries in labor room and Obstetrics OT,
taking rounds of neonates in the postnatal
wards, taking care of sick neonates in the
Pediatric Ward (who are not admied in the

94
SNCU due to lack of space) and running the
follow up clinic.
They should be exclusively involved in the care
of neonates.
They should also be involved in the training
programmes related to newborn health for
nurses, medical ocers and health workers
conducted for the enre district.
Considering the work load at least 4 medical
ocers would be the minimum requirement
for running such a unit.
The medical ocers with requisite qualicaons
who have worked in a district level SNCU for at
least 2 years should be considered favorably for
promoon.
Sta Nurse
21 for 12 SNCU beds and 6 Step Down Unit
beds.
For SNCU -Nurse-baby rao:1:3-4 in each shi.
For Step Down Unit- Nurse-baby rao:1:6-8 in
each shi.
To cover day o, leave, sickness 30% extra.
Nurse-in charge/Nursing Supervisors
Preferably should have experience in accredited
Level II unit.
Should have good managerial skills.

Should be clinically sound so as to take care of
the neonates in the absence of doctor.
There should 1 for every shi with 1 extra to
cover day o, leave, sickness etc.
@()3+9*<(2 #?0)(
For conducng in- service trainings.
Public Health Nurse
One should be exclusively aached to the unit.
Addional Sta Nurse
This should be mandatory for providing care to
the neonates at birth, neonates in the postnatal
wards and Pediatric ward where the neonates
are not looked aer properly.
Neonatal Aides/Yashodas/Mamta
Eight (2 per shi, 2 for covering day o, leave,
sickness etc. would be of immense help.
Other sta
Laboratory Technician for side laboratory.
Maintenance Sta (for roune electrical,
equipment and other maintenance).
Computer data entry operator.
Group D sta (2 per shi).
'7#7>%'%#$ M#."F'7$M"#
SYSTEM MIS FORMAT
A VII
S|. No. 1|t|e Va|ue
(A) nosp|ta| Stansncs
= Total OPD Aendance
1 (a) ":2
1 (b) #(1
2 BPL OPD Aendance
2 (a) ":2
2 (b) #(1
C $/<*: M4@ 72;3))3/9)
D BPL IPD admissions
E No. of Deaths
H No. of paents aended in Emergency
J Paent Bed Days (cumulave total of midnight head
count of all days of the month)
I No. of Sanconed Beds by the State Government
O No. of funconal Beds on ground
=K No. of funconal ambulance available
== No. of trips made by ambulance for paents
(8) Cperanon 1heatre
12 No. of Minor Surgeries
=C No. Major surgeries Done
(C) Materna| & Ch||d nea|th
=D No. of Normal Deliveries in Hospital
=E No. of Normal Deliveries - (BPL Category)
=H No. of C-Secon Deliveries
=J No. of C-Secon Deliveries - (BPL) Category
=I No. of Maternal Deaths
nosp|ta| Month|y keport Iormat - 1
Vo|ume Ind|cators
Name of the hospital:
CS/CMS/CSI:
Hospital Manager:
Month & Year :
96
S|. No. 1|t|e Va|ue
=O No. of Neonatal Deaths
20 No. of Sll Births
21 No. of MTPs conducted
- First Trimester
- Second Trimester
(D) 8|ood 8ank
22 No. of Blood Units Issued
(L) Laboratory Serv|ces
23 No. of Lab tests done
(I) kad|o|ogy
24 No. X-Ray Taken
25 No. of ultrasound Done
(G) DISLNSAk
26 Number of drugs expired during the month Number (volume and type)
27 4(06(9<*+( /5 20?+) *-*3:*R:( No. of drugs available in the dispensary x 100/No. of drugs
as per essenal drug list for the facility
(n) Department W|se Stansnca| Data
CD A11LNDANCL
* '(23639(
R Surgery
6 4*(23*<036)
2 Orthopaedics
( Obstetrics and Gynaecology
5 @(9<*:
+ Ophthalmology
h &839 *92 P@
3 T.B.
\ E.N.T.
8 Psychiatry
: M!$!
; Others (if any)
9 Others (if any)
Total opd aendance
ID A11LNDANCL
ID]Adm|ss|ons]Deaths]
keferra|s
1ota|
Adm|ss|ons
8L D|scharge Death keferred Abscond|ng LAMA
* '*:( '(236*: 1*02
R .(;*:( '(236*: 1*02
6 '*:( &?0+36*: N*02
2 .(;*:( &?0+36*: N*02
( 4*(23*<036 1*02
5 Gynaecology ward
+ "R)<(<036 1*02
h Eye ward
3 Emergency ward
\ M!U
8 #M!U
97
nosp|ta| Month|y keport Iormat - 2
erformance Ind|cators
Name of the hospital:
CS/CMS/CSI:
Hospital Manager:
Month & Year :
S|. No. 1|t|e Metr|c now Va|ue]Deta||s
(A) nosp|ta| Stansncs
= Bed occupancy Rate
(BOR)
F*<( Total Paent Bed Days (Funconal Beds in
Hospital Calendar Days in month) 100 Bed
Paent days- Sum of daily paent census for
whole month
2 Bed Turnover Rate
(BTR)
F*<( Inpaent discharge including deaths in the
month Funconal Bed on Ground
C Average Length of
Stay (ALOS)
F*<( Total Paent Bed Days in the month ( excluding
Newborn) Discharges in the month (including
Death, LAMA, absconding)
D T7'7 F*<( F*<(V=KKK 72; Total No. of LAMA cases 1000 Total No. of
72;3))3/9)
E Nurse to Bed rao Rao Total No. of Nurses Total
Hospital Beds
(8) D|spensary
H #?;R(0 /5 20?+) (LB30(2
during the month
#?;R(0 Number (volume and type)
J 4(06(9<*+( /5 20?+)
*-*3:*R:(
4(06(9< No. of drugs available in the dispensary x 100/
No. of drugs as per essenal drug list for the
facility
(C) Cperanon 1heatre
I 4(06(9< /5 !*96(::(2
)?0+(03()
4(06(9< Surgeries Cancelled x 100 Total surgeries
B(05/0;(2
O Total No. of death on
Operaon Table and
Postoperave Deaths
#?;R(0) !/?9<
=K Anaesthesia related
mortality
#?;R(0) !/?9<
ID A11LNDANCL
ID]Adm|ss|ons]Deaths]
keferra|s
1ota|
Adm|ss|ons
8L D|scharge Death keferred Abscond|ng LAMA
: %#$
; BURN Ward
9 Any other ward
/ Isolaon Ward
$/<*:
98
== Surgical site Infecon Rate F*<( No. of Post surgical infected cases x 100/Total
No. of surgeries
(D) Materna| & Ch||d nea|th
12 T&!& F*<( F*<( No. of CS delivery x 100 No. of Total delivery
=C Neonatal Mortality (less
than 28 days)
#?;R(0 No. of newborn dying under 28 days of age
=D Infant Mortality (less than
one year)
#?;R(0) No. of infant dying under one year of age
=E Percentage of mothers
leaving hospital in less
than 48 hrs.
B(06(9< no. of mothers leaving hospital in less than 48
hrs of delivery x 100 Total No. of delivery
=H Percentage of mothers
geng JSY benets within
48 hours of delivery
4(06(9< No of instuonal deliveries, receiving JSY
benets within 72 hrs. of delivery 100 Total
no. of mothers entled
(L) 8|ood 8ank
=J 4(06(9<*+( /5 @(;*92
met by Blood Bank
#?;R(0) No. of Units issued x 100 No. of Units
Demanded by the hospital
(I) Laboratory Serv|ces
=I Validaon by external
:*R/0*</03()
#?;R(0) Number of validaon per month
=O Sputum Posive
F*<(
F*<( No. of slide found posive in AFB x 100 Total
):32( 40(B*0(2 5/0 <()<
20 M P Posive Rate F*<( No. of slide found posive for Malaria Parasite
x 100 Total slide Prepared for test
21 Cycle Time for Diagnosc
Reporng
A/?0) Sum of total me in delivering reports Total
Reports *measure at least for ve paents in
a month that includes- OPD-2, Male Ward-1,
Female Ward-1 Emergency-1
(G) kADICLCG
22 Cycle me for X-Ray
Reporng
'39?<()VA/?0) '(*)?0(
(n) nCUSL kLLING
23 Total No. of Cleaning
Sta available per day
(Outsourced/Contract/
Regular)
#?;R(0 #?;R(0
24 #?;R(0 /5 $/3:(<) *92
Availability of Checklist in
all the Toilets
Number &
Availability
@(<*3:) /5 9?;R(0 /5 $/3:(<)
& Availability of check list in each toilet Check
for:
Availability of running water
Availability of funconal cisterns
!:(*9:39())
Broken seats & les
N*<(0 :/++39+
a.
b.
c.
d.
e.
Sr. No. 1|t|e Metr|c now Va|ue]Deta||s
99
25 Name of Other
Crical Areas/Wards
& Availability of Checklist
in all these departments
Name &
Availability
Details of number of Crical Areas/Wards &
Availability of check list in each of these areas
$*B) No water leakage from taps/overhead tanks
N*02 !:(*9 1*02)V6/0032/0)
@0*39) No clogged/overowing drains
Laundry services Total no of bed sheets washed in a month/
Paent bed days in a month
(I) nCSI1AL INILC1ICN CCN1kCL
26 #?;R(0 /5 !?:<?0(
&?0-(:3*96( 6/92?6<(2
#?;R(0 Number of Culture Surveliance with details of
departments in which they are conducted.
Reports of Surveliance to be aached
27 Biomedical Waste
'*9*+(;(9<
Check for
Display the work instrucon at the point of
segregaon
Availability of coloured liners
Availability of colour coded bins at the point
of BMW generaon
Segregaon of BMW at the point of
generaon
Availability of sharp pit and disposal of
sharp as per rule
Availability of deep burial pit and disposal
of placenta and other anatomical wastes as
B(0 0?:()
Availability of PPE(personal protecve
equipment) with biomedical waste handler
Availability of sodium hypochlorite soluon
*92 B?96<?0( B0//5 R/L()
Mulaon and disinfecon of the plasc
1*)<( R(5/0( 23)B/)*:
Authorizaon under BMW management
rules 1996.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
(I) LNGINLLkING AND MAIN1LNANCL
28 Down Time Crical
(G?3B;(9<
In Hours/Days Total me crical equipment cannot be used
R(6*?)( /5 R(39+ /?< /5 /02(0
29 No. of Instrument
!*:3R0*<(2
#?;R(0) !/?9<
(k) 1kAININGS
CK No. of trainings conducted 6/?9< Aach a note on training that includes-
1. Topic
2. No. of trainee
3. Name of trainer
4. Schedule
(L) SLCUkI1 SLkVICLS
C= Total No. of guards
available per day
#?;R(0 !/?9<
Sr. No. 1|t|e Metr|c now Va|ue ]Deta||s
100
(M) A1ILN1 SA1ISIAC1ICN SUkVL
32 Paent Sasfacon Survey
&6/0( 5/0 "4@
&6*:( = $" E 1) Survey
2) Analysis
3) Acon Plan on Analysis
* Reports to be aached
CC Paents rights and
informaon
Check for:
Cizen charter availability and prominently
displayed
Emergency signage prominently displayed
Help desk/enquiry counter with availability
/5 2(236*<(2 B(0)/9
User charges (OPD/IPD/Diagnoscs/blood
bank/others) prominently displayed
Availability of drugs prominently displayed
(at dispensary and IPD)
Departmental signage prominently
displayed
Display of mandatory informaon (under
the PNDT/RTI etc.
Complaint/suggeson box prominently
B:*6(2
Safety /hazard and cauon sign prominently
displayed.
Consent pracced (OT/IPD/MTP/HIV tesng
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
CD Paent Sasfacon
Survey Score for IPD
&6*:( = $" E 1) Survey
2) Analysis
CE Waing me taken for
OPD registraon
M9 ;39?<() Duraon for which Paent has to wait for OPD
registraon
CH No. of Complaints/
Sugges ons Received
#?;R(0) !/?9<
CJ Waing me for
OPD Consultaon
M9 ;39?<() Survey
CI Waing me at
Dispensary
M9 ;39?<() Survey
CO Sta Sasfacon
Survey Score
&6*:( = </ E 1) Survey
2) Analysis
(M) A1ILN1 SA1ISIAC1ICN SUkVL
*Paent Sasfacon Survey to be conducted Quarterly.
(N) CCMMUNI1 Ak1ICIA1ICN (kkS)
DK Number of RKS meeng
held in the month
#?;R(0 !/?9<
101
D= Ulizaon of RKS funds Rs. 1. Opening Balance of RKS account for Month
2. Expenditure in the Month
3. Funds Received/ Income in the month
4. Fund raised through NGO/PRI/corporate/
source through that state government.
(C) IN1LkNAL, MLDICAL AUDI1 AND DLA1n AUDI1
42 M9<(09*: 7?23< 6/92?6<(2
during the month (Yes /
No)
Yes / No 1) Details to be aached including report, if
*?23< 6/92?6<(2
2) If Internal Audit not conducted in thios
month then specify the due date for the
same.
DC Death Audit conducted
during the month (Yes /
No)
#?;R(0 Medical Audit Conducted - YES / NO
Number of cases disucssed ?
DD '(236*: 7?23<) 6/92?6<(2
during the month
V#?;R(0 /5 6*)()
23)6?))(2
#?;R(0 Medical Audit Conducted - YES / NO
Number of cases disucssed ?
() MANAGLMLN1 kLVILW MLL1ING
DE 'F' 6/92?6<(2 2?039+
the month
#?;R(0 1) MRM Conducted - YES / NO
2) MOM to be aached.
3) Acon plan to be aached
() AN IUND kLLLASL ] AkCnI1LC1UkAL DLVLLCMLN1 ] kLAIk DCNL DUkING 1nIS MCN1n
DH Any Fund Release
/Architectural
@(-(:/B;(9<VF(B*30 2/9(
during the month
@(<*3:) Aach details if any
(k) AN C1nLk MAICk LVLN1 ] kLMAkkS
DJ Any other Major
%-(9<)VF(;*08)
@(<*3:) Aach details if any
No objecon cercate from the Competent
Fire Authority
Authorisaon under Bio-medical Waste
(Management and Handling) Rules, 1998
Hazardous Waste (Management, Handling
and Trans-boundary Movement) Rules
2008
Authorisaon from Atomic Energy Regulaon
Board
%L63)( B(0;3< </ )</0( &B303<
Vehicle registraon cercates for
Ambulances.
Consumer Protecon Act
Drug & Cosmec Act 1950
.*<*: 76632(9<) 76< =IEE
Indian Lunacy Act 1912
M923*9 '(236*: !/?963: 76< *92 6/2( /5
Medical Ethics
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
LIST OF STATUTORY COMPLIANCES
A VIII
M923*9 #?0)39+ !/?963: 76<
Inseccides Act 1968
Maternity Benet Act 1961
Boilers Act as amended in 2007
'$4 76< =OJ=
Persons with Disability Act 1995
PC & PNDT Act 1994
4#@$ 76< =OOH
License for Blood Bank or Authorisaon for
Blood Storage facility
Right to Informaon act
Narcocs and psychotropic substances act
=OIE
Clinical Establishments (Registraon and
Regulaon) Act 2010
Type and Site Approval from AERB for X-ray, CT
Scan unit.
Mental Health Act 1987
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Seismic safety of non-structural
elements of Hospitals/Health facility
Health Facility/Hospital should remain intact and
funconal aer an earthquake to carry on roune
and emergency medical care.
There may be increased demand for its services
aer an earthquake.
Hospital accommodates large number of paents
who cannot be evacuated in the event of
earthquake.
Hospitals have complex network of equipment
specialised furniture, ducng, wiring, electrical,
mechanical ngs which are vulnerable due to
earthquake.
The Non-structural element may value very high
from 80% to 90% incase of Hospital unlike oce
buildings due to specialized medical equipment.
Even if building remains intact, it may be rendered
non-funconal due to damage to equipment,
pipelines, fall of parons and store material, etc.
While the safety of building structure is the duty of
PWD and designers of the building, the risk of non-
structural component has to be dealt by sta and
authories of the health facility.
This non-structural Migaon & reducon of risk
can be achieved through series of steps:
Sensizaon (understanding earthquakes and
safety requirements).
Earthquake Hazard Idencaon in the
hospital.
i)
ii)
SEISMIC SAFETY GUIDELINES
A IX
Hazard survey and priorizaon.
Reducing non-structural hazards.
Step I: Understanding Earthquakes and
Safety requirements
Awareness and sensizaon about safety.
The structural elements of a building carry the
weight of the building like columns, beams,
slabs, walls, etc.
The Non-structural elements do not carry
weight of the building, but include windows,
doors, stairs, paron and the building contents:
furniture, water tank, hospital equipment,
medical equipment, pharmacy items and basic
installaon like water tanks, medical gases,
pipelines, air condioning, telecommunicaons,
electricity etc.
Step II: Earthquakes hazard idencaon in
the hospital
Tall, narrow furniture like cupboards can fall on
people, block doors/passages/exits.
Items on wheels or smooth surfaces can roll
and crash.
Large and small things on shelves, etc. can
knock, fall, crash and damage severely.
Hanging objects can fall.
Shelves/almirahs, storage cabinets can topple
and block exits and obstruct evacuaon.
Pipes can break and disrupt water supply.
iii)
iv)

104
Step III: Reducing non-structural hazard
To relocate furniture and other contents.
To secure non-structural building elements with
the help of structural engineers.
To secure the furnishings and equipment to
the walls, columns or the oors with help of
engineers and technicians.
1.
2.
3.
Step IV: Hazard Survey and Priorizaon
All the non-structural hazard should be idened
systemacally and priorise for as high, medium or low
priority and acon taken immediately or in due course.
This involves systemac survey and categorisaon of all
hazards in each area of the hospital and acon thereof.
Hospital/health facility should have a Commiee
dedicated to undertake this task and monitor on
connuous ongoing basis.
NC1L
This form must be completed for all deaths, including aborons and ectopic gestaon related deaths, in pregnant
women or within 42 days aer terminaon of pregnancy irrespecve of duraon or site of pregnancy.
Aach a copy of the case records to this form.
Complete the form in duplicate within 24 hours of a maternal death. The original remains at the institution where
the death occurred and the copy is sent to the person responsible for maternal health in the State.
For Oce Use Only:
FB-MDR no: .................... Year:.....................
FACILITY BASED MATERNAL
@%7$A F%PM%N ."F'
A X
1. Genera| Informanon:
Address of Contact Person at District and State:
........................................................................................
........................................................................................
Residenal Address of Deceased Woman:
........................................................................................
Address where Died:
........................................................................................
Name and Address of facility:
........................................................................................
Block: ..............................................................................
District: ..................... State:..........................
2. Deta||s of Deceased Woman:
Name: ................................................................
Age (years) :................... Sex: ........................
Inpaent Number: ............................................
Gravida:
Live Births (Para): ........... Aborons: ..............
No. of Living children: .......................................
Timing of death:
During pregnancy
during delivery
within 42 days of delivery
Days since delivery/aboron:
Date and me of admission:
Date/Time of death:
I.
II.
III.
IV.
V.
VI.
3. Adm|ss|on at Insntunon Where Death Cccurred or from Where |t was keported,
Type of facility where died:
4A! 24 x 7 PHC &@AV0?0*:
A/)B3<*:
@3)<036<
A/)B3<*:
'(236*: !/::(+(V
terary Hospital
403-*<(
A/)B3<*:
4-< !:3936 Other
I.
106
Stage of pregnancy/delivery at admission:
Aboron Ectopic pregnancy #/< 39 :*R/?0 M9 :*R/?0 4/)<B*0<?;
Stage of pregnancy/delivery when died:
Aboron Ectopic pregnancy #/< 39 :*R/?0 M9 :*R/?0 4/)<B*0<?;
Duraon of me from onset of complicaon to admission:
Condion on Admission:
&<*R:( U96/9)63/?) &(03/?) Brought dead
Referral history:
Referred from another centre ? How many centres? Type of centre?
4. Antenata| Care
F(6(3-(2 79<(9*<*:
6*0( /0 9/<
F(*)/9) 5/0 9/<
0(6(3-39+ 6*0(
Type of ante-natal
6*0( B0/-32(2
High risk
pregnancy: aware
of risk factors?
what risk factors?
S. De||very, uerper|um and Neonata| Informanon
Deta||s of |abor
had labor pains or not stage of labor when died duraon of labor
Deta||s of de||very
?92(:3-(0(2 9/0;*: assisted (forceps or vacuum) surgical intervenon (C-secon)
uerper|um:
Unevenul Evenul (PPH/Sepsis etc.)
Comments on |abour, de||very and puerper|um: (|n box be|ow)
Neonata| Cutcome
sllborn neonatal death immediately aer birth alive at birth alive at 7 days
Comments on baby outcomes (in box below)
6. Intervennons
Specic medical )?0+36*: B0/6(2?0() rescuscitaon procedures undertaken
7. Cause of Death
II.
III.
IV.
V.
VI.
i.
ii.
iii.
iv.
107
Probable direct obstetric (underlying) cause of
death: Specify
Indirect Obstetric cause of death: Specify
Other Contributory (or antecedent) cause/s:
Specify
Final Cause of Death: (aer analysis)
8. Iactors (other than med|ca| causes ||sted above)
Personal/Family
Logiscs
Facilies available
Health personnel related
9. Comments on potenna| avo|dab|e factors, m|ssed
opportun|nes and substandard care
a.
b.
c.
d.
a.
b.
c.
d.
10. AU1CS: erformed]Not erformed
If performed please report the gross ndings and send
the detailed report later.
11. CASL SUMMAk: (p|ease supp|y a short summary
of the events surround|ng the death):
12. Iorm ||ed by:
13. Name
14. Des|gnanon
1S. Insntunon and |ocanon
16. S|gnature and Stamp
17. Date:
Note: To facilitate the invesgaon, for detailed
Quesons refer to annexures on FBMDR.
ANC : Ante Natal Care
ANM : Auxiliary Nurse Midwife
AYUSH : Ayurveda, Yoga & Naturopathy, Unani,
Siddha and Homoeopathy
BJMC : BJ Medical College
CBR : Community Based Rehabilitaon
CRI : Central Research Instute
CRME : Centre for Research in Medical Entomology
CSSD : Central Sterile Supply Department
DEC : Di Ethyl Carbamazine
DF : Deep Freezer
DRDE : Defense Research and Development
Establishment
ECG : Electro Cardio Graphy
ESR : Erythrocyte Sedimentaon Rate
EVRC : Enterovirus Research Centre
FRU : First Referral Unit
HSADL : High Security Animal Diseases Laboratory
ICTC : Integrated Counselling and Tesng Centre
ICGEB : Internaonal Centre for Genec Engineering
and Bio-technology
IEC : Informaon, Educaon and Communicaon
IGIB : Instute of Genomics and Integrave Biology
IVRI : Indian Veterinary Research Instute
ILR : Ice Lined Refrigerator
Inj : Injecon
IPHS : Indian Public Health Standards
I/V : Intravenous
IUCD : Intra-urine Contracepve Devise
JE : Japanese Encephalis
KEM : King Edmund Memorial Hospital
LAMA : Le Against Medical Advice
LTs : Laboratory Technicians
MIS : Management Informaon System
LIST OF ABBREVIATIONS
A XI
MRC Malaria Research Centre
NACP : Naonal AIDS Control Programme
NHP : Naonal Health Programme
NARI : Naonal AIDS Research Instute
NEERI : Naonal Environmental Engineering Instute
NICED : Naonal Instute of Cholera and Endemic
@3)(*)()
NIV : Naonal Instute of Virology
NRHM : Naonal Rural Health Mission
NSV : Non Scalpel Vasectomy
NVBDCP : Naonal Vector Borne Disease Control
40/+0*;;(
OPD : Out Paent Department
OT : Operaon Theatre
PMR : Physical Medicine and Rehabilitaon
PNC : Post Natal Care
POL : Petrol Oil and Lubricant
PPH : Post Partum Haemorrhage
PPTCT : Prevenon of Parent to Child Transmission
PRI : Panchaya Raj Instuon
RCH : Reproducve & Child Health
RKS/HMC : Rogi Kalyan Sami/Hospital Management
Commiee
RMRC : Regional Medical Research Centre
RTI/STI : Reproducve Tract Infecons/Sexual Tract
Infecons
SNCU : Special Newborn Care Unit
SOPs : Standard Operang Procedures
STM : School of Tropical Medicines
TENS : Transcutaneous Electrical Nerve Smulaon
VCRC : Vector Control Research Centre
WC : Water Closet (i.e. a ush toilet)
Indian Standard Basic Requirement for Hospital
Planning; Part 2 Upto 100 Beded Hospital,
Bureau of Indian Standards, New Delhi,
January, 2001.
Raonalisaon of Service Norms for
Secondary Care Hospitals, Health & Family
Welfare Department, Govt. of Tamil Nadu.
(Unpublished).
District Health Facilies, Guidelines for
Development and Operaons; WHO; 1998.
1.
2.
3.
F%.%F%#!%&
Indian Public Health Standards (IPHS) for
Community Health Centres; Directorate General
of Health Services, Ministry of Health & Family
Welfare, Govt. of India.
Populaon Census of India, 2001; Oce of the
Registrar General, India.
Prof. Anand S. Arya, under the GOI- Disaster Risk
Management Programme, Naonal Disaster
Management Division, MHA, New Delhi.
4.
5.
6.
MEMBERS OF TASK FORCE FOR
F%PM&M"# ". M4A&
Dr. R.K. Srivastava, Director General of Health
Services Chairman
Dr. Shiv Lal, Special DG (PH), Dte.GHS, Nirman
Bhawan, New Delhi Co-Chairman.
Sh. Amarjit Sinha, Joint Secretary, NRHM,
Ministry of Health & F.W., Nirman Bhawan, New
Delhi.
Dr. Amarjit Singh, Execuve Director,
Jansankhya Sthirata Kosh, Bhikaji Cama Place,
New Delhi - 110066.
Dr. B. Deoki Nandan, Director Naonal Instute
of Health & Family Welfare, Baba Gang Nath
Marg, Munirka, New Delhi 110067
Dr. T. Sunderraman, Execuve Director, Naonal
Health Systems Resource Centre, NIHFW
Campus, Baba Gang Nath Marg, Munirka,
New Delhi 110067.
Dr. N.S. Dharmshaktu, DDG (NSD), Dte.G.H.S.,
Nirman Bhawan, New Delhi.
Dr. S.D. Khaparde, DC (ID), Ministry of Health &
F.W., Nirman Bhawan, New Delhi.
Dr. A.C. Dhariwal, Addional Director (PH)
and NPO, Naonal Centre for Disease Control
(NCDC), 22, Sham Nath Marg, New Delhi
110054.
Dr. C.S. Pandav, Prof. and Head, Community
Medicine, AIIMS, New Delhi.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Dr. J.N. Sahay, Advisor on Quality improvement,
Naonal Health Systems Resource Centre,
NIHFW Campus, Baba Gang Nath Marg, Munirka,
New Delhi 110067.
Dr. Bir Singh, Prof. Department of Community
Medicine, AIIMS and Secretary General.
Indian Associaon of Prevenve and Social
Medicine.
Dr. Jugal Kishore, Professor of Community
Medicine, Maulana Azad Medical College,
Bahadur Shah Zafar Marg, New Delhi 110002
Mr. J.P. Mishra, Ex. Programme Advisor,
European Commission, New Delhi
Dr. S. Kulshreshtha, ADG, Dte. GHS., Nirman
Bhawan, New Delhi.
Dr. A.C. Baishya, Director, North Eastern Regional
Resource Centre, Guwaha, Assam.
Dr. S. K. Satpathy, Public Health Foundaon of
India, Aadi School Building, Ground Floor, 2
Balbir Saxena Marg, New Delhi 110016.
Dr. V.K. Manchanda, World Bank, 70, Lodhi
Estate, New Delhi 110003.
Sh. Dilip Kumar, Nursing Advisor, Dte. G.H.S.,
Nirman Bhawan, New Delhi.
Dr. Anil Kumar, CMO (NFSG), Dte.G.H.S, Nirman
Bhawan, New Delhi- Member Secretary
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
(As rrn onbrn No. 1 2101S]SS]09 NCD, Dtr.GnS, bntrb 29-1-2010 nNb mNutrs or
mrrtNc or 1nsx Ioncr nrtb oN 12-2-2010)
112
D|rectorate Genera| of nea|th Serv|ces
>/-(09;(9< /5 M923*

Guidelines For Distt Hospitals - Indian Public Health Standards

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Guidelines For Distt Hospitals - Indian Public Health Standards

Încărcat de

Drepturi de autor:

Formate disponibile

Indian Public Health Standards (IPHS)

District Hospitals have come under constantly

Indian Public Health Standards (IPHS): Guidelines for @M&$FM!$ A"&4M$7T&

Indian Public Health Standards (IPHS): Guidelines for @M&$FM!$ A"&4M$7T&

Crowds should be controlled and only the

Indian Public Health Standards (IPHS): Guidelines for @M&$FM!$ A"&4M$7T&

Indian Public Health Standards (IPHS): Guidelines for @M&$FM!$ A"&4M$7T&

S|. No. Spec|a||ty D|agnosnc Serv|ces]1ests

Laboratory Services at District Hospital

Department koom no. 1|m|ngs

The Bio-Medical Waste (Management & Handling)

GUIDELINES FOR AIR BORNE

1|me Cut (Period aer inducon &

S|gn Cut (Period from wound closure

1each|ng koom: The SNCU also serves as a teaching

Indian Public Health Standards (IPHS): Guidelines for @M&$FM!$ A"&4M$7T&

can be easily cleaned and is essenal requirement.

I|oor|ng type In|na| cost Durab|||ty Comfort]sound

Goals were to avoid direct infant lighng exposure:

Indian Public Health Standards (IPHS): Guidelines for @M&$FM!$ A"&4M$7T&

They are primarily responsible for the complete

Indian Public Health Standards (IPHS): Guidelines for @M&$FM!$ A"&4M$7T&

Should have good managerial skills.

Indian Public Health Standards (IPHS): Guidelines for @M&$FM!$ A"&4M$7T&

S-ar putea să vă placă și