HOUSEKEEPING SERVICES

MANUAL

Quality Assurance Division

Haryana State Health Resource Centre,
Government of Haryana

CONTENTS
1.0 INTRODUCTION..4
2.0 OBJECTIVES AND PURPOSE OF MANUAL5
3.0 DEFINITIONS.5
4.0 DEPARTMENTAL STRUCTURE..6
5.0 HOUSEKEEPING PROTOCOLS FOR A DISTRICT HOSPITAL.7
PART-1 CLEANING AND DISINFECTION OF PATIENT CARE AREAS
6.0 ENVIRONMENTAL CLEANING AND DISINFECTION IN HIGH RISK AREAS.9
6.1 CLEANING AND DISINFECTION IN OPERATION THEATRE ENVIRONMENT.9
6.2 DISINFECTANTS TO BE USED ...9
6.3 PREPARATION AND CONCENTRATION OF DISINFECTANTS..10
6.4 SUGGESTIVE CLEANING SCHEDULE FOR OPERATION THEATRE10

7.0 CLEANING AND DISINFECTION IN LABOUR ROOM.12

8.0

CLEANING AND DISINFECTION IN ISOLATION ROOMS..12

9.0

CLEANING AND DISINFECTION OF EMERGENCY ROOMS

AND THE INTENSIVE CARE UNITS..13

10.0 DISINFECTION OF PATIENT CARE UTILITIES.14

11.0 CLEANING AND DISINFECTION OF LABORATORY ...15
12.0 CLEANING AND DISINFECTION OF OUT PATIENT DEPARTMENT15
13.0 CLEANING AND DISINFECTION OF DRESSING ROOM..16
14.0 CLEANING AND DISINFECTION OF INPATIENT WARDS ..16

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

1.0 CLEANING AND DISINFECTION OF CORRIDORS..20
2.0 CLEANING DISINFECTION OF TOILETS.20
3.0 CLEANING AND DISINFECTION OF LIFT..21
PART-3 SPILL MANAGEMENT, BIOMEDICAL WASTE MANAGEMENT
AND OTHER PROTOCOLS
1.0 GUIDELINES FOR SPILL MANAGEMENT: SPILL MANAGEMENT OF BLOOD &
BODY FLUID .23
2.0

BIO-MEDICAL WASTE MANAGEMENT26

2.1 BIOMEDICAL WASTE SEGGREGATION CHART26
2.2 BIO MEDICAL WASTE MANAGEMENT HANDLING RULES 199827

3.0 MANAGEMENT OF LOST AND FOUND ITEMS .31

4.0 MANANGEMENT OF PEST CONTROL.31
5.0 RECORDS TO BE MAINTAINED BY THE HOUSEKEEPING SUPERVISOR..31
6.0 SUGGESTIVE LIST OF EQUIPMENT/GADGETS/MACHINERY
FOR HOUSEKEEPING DEPARTMENT...33

1.0 INTRODUCTION
It is said that the first impression lasts till the
end

Hospital cleanliness is the first impression that any patient

or relative makes while entering a hospital.
A clean and hygienic environment has a tremendous
psychological impact on the patients and the family members,
and speaks volumes about the quality of service the hospital
provides. Since it is difficult for people to judge the clinical
services in a hospital due to lack of medical knowledge, opinion
about a hospital is often formed on the basis of its appearance

Tardiness
and
Cleanliness are the basic
tenets of maintaining a
healthy, environment.
In
Government
Hospitals it becomes
absolutely essential to
maintain hygiene despite
high volumes of patients
visiting the Out Patient
Departments.

and cleanliness.
Housekeeping services in a hospital has a major role in
controlling the infection rate as well as minimizing the
Hospital acquired infections to the patients. Effective
housekeeping prevents diseases and spread of infections
reducing medical costs and the amount of sickness among
patients and other visitors.

2.0 OBJECTIVES AND PURPOSE OF MANUAL

In government hospitals regular cleaning and disinfection is essential because of the
high turnover of patients, Standardization of cleaning methods, materials, checklists is
essential. Some of the Objectives of the manual are:
1. Standardized protocols for housekeeping services would ensure that cleaning,
disinfection is adequately done
2. The types of solutions, type of material to be used for cleaning/ disinfection
purposes would be identified.
3. Manual would provide the hospital with standard document for training protocols
for various housekeeping procedures. Checklists to be used for cleaning,
disinfection purposes and daily monitoring of various activities would be available
and can be used for references.
4. It would help in maintaining the hospital clean, orderly and infection free.
5. Establish and maintain procedures to ensure standards of quality. This would
include cleaning of windows, walls, floors, furniture and equipments.
6. Standardize various processes for waste segregation and disposal in coordination
with the infection control team.

3.0 DEFINITIONS1
There are various types of methods used in maintaining sanitation in the hospitals.
Some of the Definitions are given below:
1) CLEANING: Cleaning is the removal of visible soil (e.g., organic and inorganic material)
from objects and surfaces and normally is accomplished manually or mechanically using
water with detergents.
2) DISINFECTION: Disinfection describes a process that eliminates many or all pathogenic
microorganisms, except bacterial spores, on inanimate objects.
3) DISINFECTANT: Disinfectants are antimicrobials applied only to inanimate objects
4) DECONTAMINATION:

Decontamination removes pathogenic microorganisms from

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

5) DAMP DUSTING : A process of cleaning which involves the use of wet cloth
1

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

4.0 DEPARTMENTAL STRUCTURE

The Housekeeping department in Government hospitals/ health care
facilities is usually outsourced to an external agency, an MOU / Agreement is
developed between the Hospital management and the external agency. The terms of
reference should be clearly defined in the MOU, in order to define the Key
Performance Indicators upon which the work is measured.
A suggestive organization Structure of Housekeeping department for a
district hospital is given below:
HOUSEKEEPING DEPARTMENT

Principal Medical Officer / Medical Superintendent/

Senior Medical Officer I/c
Hospital Administrator/Deputy Medical Superintendent
Housekeeping Supervisor

General Duty Attendants / Class IV/

Sweeper / Group D Staff

5.0 HOUSEKEEPING PROTOCOLS FOR A DISTRICT HOSPITAL

According to Cleaning and Disinfection purposes, hospital is categorically
divided into different areas according to the risk of various Hospital Acquired
infections. The different areas are classified into: Patient Care Areas and Non Patient
Care Areas.
INPATIENT CARE AREAS:
The patient care areas are divided into 3 types- High risk, Medium risk and
Low risk. The risk of hospital infections is high in High risk patient care areas
because of high content of microbial load as in isolation rooms or due to
susceptibility of the bacteria to invade open tissues.
The various patient care areas are given below:
A. Patient Care Areas
(1)

High risk areas :

Operation Theatre
Labor Room
Isolation Rooms
(2) Medium Risk Areas :
Patient Inpatient wards
Emergency Department
Laboratory
Radiology
Dirty Utility Area
Mortuary
(3) Low Risk areas :
OPD / Consultation Rooms
B. Non Patient care areas
Corridors
Toilets
Lifts
Waiting halls / Waiting Rooms
Stores (Medicine Store, Linen Store)
Pharmacy

PART-1

CLEANING AND DISINFECTION

OF
PATIENT CARE AREAS

(A) PATIENT CARE AREAS

6.0 ENVIRONMENTAL CLEANING AND DISINFECTION IN HIGH RISK AREAS
6.1 CLEANING AND DISINFECTION IN OPERATION THEATRE ENVIRONMENT
AND LABOUR ROOM
A) CLEANING/ DISINFECTION BEFORE SURGERY

All horizontal surfaces with in the OT are damp dusted before the first scheduled
surgical procedure of the day with a clean cloth moistened in the approved
disinfectant solution.
Visual inspection of OT area, equipments, OT Table before commencement of the
first surgical case.

B) CLEANING/ DISINFECTION DURING SURGICAL PROCEDURE

Accidental spillage (Blood and Body Fluids) in the area outside the surgical field
should be promptly cleaned by placing tissue papers over it then pouring 1%
sodium hypochlorite over it.
Leave it for 15 minutes then collect it, then mop with a disinfectant.
Discard the contaminated disposable items in yellow bag meant for Biomedical
Waste.

C) CLEANING/ DISINFECTION IN BETWEEN SURGICAL PROCEDURE

Conduct a visual check to inspect cleanliness of the operation theatre

Reusable Suction bottles are emptied and cleaned under the running water and
tubing is replaced.
Respiratory tubing is cleaned under running water and sent for autoclaving.
Floor cleaning is done in area around the sterile field with sodium hypochlorite.

D) CLEANING IN OT AT THE END OF THE DAY

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

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

6.2 DISINFECTANTS TO BE USED

Formaldehyde (Formalin) and Gluteraldehyde (Cidex)

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

6.3 PREPARATION AND CONCENTRATION OF DISINFECTANTS

Formaldehyde and gluteraldehyde

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

For fogging: 2%

Hydrogen peroxide and silver nitrate

For surface cleaning make 5% of the solution: add 250ml in 5 liters of water.
For Fogging: make 20% concentration of solution (200ml in 1000 ml)

Sodium Hypochlorite

75 ml in 12 liters of water (1%)

6.4 SUGGESTIVE CLEANING SCHEDULE FOR OPERATION THEATRE AND

LABOUR ROOM
CLEANING
AREAS

MATERIAL USED

RESPONSIBILITY

DAILY

OT Table

1% Sodium
hypochlorite Sol.

OT Housekeeper

Delivery Table

1% Sodium
hypochlorite Sol.

Housekeeper

OT light

1% Sodium
hypochlorite Sol.

OT Housekeeper

At least once or as
per requirement
between each
surgery in a day
At least once or as
per requirement
between each
delivery in a day
At least once or as
per requirement

Crash Cart

1% Sodium
hypochlorite Sol.

OT Housekeeper

At least Once or as
per requirement

Ventilator

1% Sodium
hypochlorite Sol.

OT Housekeeper

At least Once or as
per requirement

Scrub Trolleys

1% Sodium
hypochlorite Sol.

OT Housekeeper

At least Once as per

requirement

Drums

Wet mop

OT Housekeeper

Once

Racks

Disinfectant sol.

OT Housekeeper

Once

WEEKLY

MONTHLY

10

Glass Wall

Disinfectant sol.

OT Housekeeper

Once

Wall

Disinfectant sol.

OT Housekeeper

Once

Floor

Disinfectant sol.

OT Housekeeper

Twice or as per
requirement

TV

Disinfectant sol.

OT Housekeeper

Once

C- arm

Disinfectant sol.

OT Technician

Once

Suction

Detergent &
SAVLON SOL

OT Housekeeper

Twice or as per
requirement

Sink

Disinfectant sol.

OT Housekeeper

Twice or as per
requirement

Fridge

Internal- Detergent

OT Housekeeper

Once

AC ducts

Vacuum cleaning,
Disinfectant sol.

HK SUPERVISOR

Frequently
touched
surfaces- Door
knobs, switch,
tap(INSIDE OT)
Frequently
touched
surfaces- Door
knobs, switch,
tap(OUTSIDE
OT)
Floor

Disinfectant sol.

House Keeper

Twice

Disinfectant sol.

House Keeper

3 times a day (Before

each shift)

Disinfectant sol.

House Keeper

Thrice or as per
requirement

Lockers

Disinfectant sol.

House Keeper

Once

Shoe rack

Wet mop

House Keeper

Once

Dust bins

Detergent

House Keeper

Once

Buckets, Dust
pans

Detergent

House Keeper

Twice

Mop

1% Sodium
Hypochloride sol.

House Keeper

Twice

ONCE

11

All furniture, wall surfaces, fixed and ceiling mounted equipments, anaesthesia
equipments and accessories, soap dispensers, handles of cabinet are to be disinfected
with either formaldehyde and gluteraldehyde or hydrogen peroxide.
1.
2.
3.
4.

Scrub sinks are cleaned with detergent solution under water.

Floor cleaning is done with 1% Sodium Hypochlorite.
Bathrooms and toilets are cleaned with detergent powder.
Suction bottles are to be emptied, cleaned and disinfected by immersing
into 1% sodium hypochlorite solution for 20mts and in case they are
infected then for 1hr.
5. Transport vehicles (trolleys and wheelchairs), including straps and
attachments are cleaned with 2% formaldehyde and gluteraldehyde or
5% hydrogen peroxide.
Weekly Cleaning
Remove all movable equipments and furniture from the O.T.
1.

Clean with wet mopping with disinfectant solution

2.

Floor cleaning to be done with scrub and vacuum.

3.

Ceiling and walls are cleaned with disinfectant/ Cidex solution.

4.

Fumigation is done at night

Mops:
1. Mops used should be cleaned with detergent periodically.
2. Post usage keep it for drying.

8.0

CLEANING AND DISINFECTION IN ISOLATION ROOMS

Isolation Rooms are specifically designed for patients requiring isolation
due to contagious diseases from being spread from a patient to other
patients, staff, and visitors, or from others to a particular patient. Another
type of patients requiring isolation is immuno-compromised patients, which
have chances of acquiring secondary infections.

12

So single bed isolation rooms are made for immune compromised whereas
muti-bedded isolation wards are made and ward for patients with similar
diagnosis like TB.
1. Change curtains after the discharge of all patients in case of a ward or every 15
days whichever is earlier.
2. Fogging to be carried out with 20% hydrogen peroxide disinfectant after
discharge of each patient.
3. Terminal cleaning with 5% hydrogen peroxide to be done at the end of each shift.
4. Special transmission based precautions i.e. blood born pathogen isolation (BBP),
airborne isolation (AI), droplet isolation (DI) and contact isolation (CI) have to be
followed for patients having specific diseases.

9.0

CLEANING AND DISINFECTION OF EMERGENCY ROOMS

AND THE INTENSIVE CARE UNITS

1. All examination tables to be cleaned daily.

2.

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

3. Sinks, soap dishes, and paper towel dispensers will be cleaned daily and
replenished.
4.
5.

All stretchers /trolleys will be cleaned weekly.

Toilets to be washed and cleaned at least thrice daily using germicidal
solution, including both sides of toilet seats in case of English toilets.

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

and thoroughly cleaned, as necessary.
7. For cleaning spray the entire area with a mixture of 20% hydrogen peroxide,
formaldehyde and Gluteraldehyde (cidex) before a new patient is admitted.
8. Change the curtains once in 7 days or as and when required.

13

10.0 DISINFECTION OF PATIENT CARE UTILITIES

ITEMS

CLEANING / DISINFECTION

TIME

Nebulizer set

Soap and water

N.A

Stethoscope

Alcohol swab

N.A

Thermometer

Isopropyl alcohol swab or soap and

water

N.A

Laryngoscope

Blade with soap & water

Handle & bulb - isopropyl alcohol.

N.A

Nasal prongs

Tap water only if dirty

N.A

Oxygen masks

Isopropyl alcohol swab

N.A

Ambu bag

If uninfected patient -isopropyl

swab,
Infected patient cidex dipped for
1 hr.

After each use

Preferably Individual for
each patient.
Clean after each use.

Preferably Individual
for each patient.
Preferably Individual
for each patient.

For 1hr
20mts to
1hr

Soap and water, Immerse in 1%

sodium hypochlorite

Transducer

Alcohol swab

Bed Side
Urinal

Soap and water immerse in 1%

sodium hypochlorite

Emesis basin

Soap and water

N.A

Measuring cup

Soap and water

N.A

Medicine
container

Soap and water

N.A

Soap and water

Individual preferred

N.A

Sputum mug

Bed pan

REMARKS

Keep a minimal amount of

water in the mugs prior to
giving to patient.

N.A
20mts to
1hr

N.A

14

11.0 CLEANING AND DISINFECTION OF LABORATORY

1. Laboratory area requires specific cleaning in different sections of the Laboratory,
Hematology, and Biochemistry section table tops should be cleaned with 1% Sodium
Hypochlorite in the morning. Microbiology sections and Histopathology sections
should be disinfected after each shift so that microbial culture built up does not
occur.
2. Laboratory areas should be free from any blood spills, they should be scraped off
3. All the dustbins shall be washed and lined with color coded bags in the morning.
Change the waste bag when it is 2/3 filled with laboratory waste.
4. Clean the walls thoroughly by using a specialized soap/disinfectant solution in the
morning.
5. The floor shall be thoroughly mopped with a disinfectant solution.
6. The common areas shall be swept and mopped in the morning and at regular
intervals to keep them clean.
7. Contaminated clothing must be decontaminated before laundering
8. Replace soap, hand towel, alcohol based hand rub when required.

12.0 CLEANING AND DISINFECTION OF OUT PATIENT

DEPARTMENT
1. Use 1% sodium hypochlorite for floor mopping.
2. Wipe all the table tops, examination table, dressing trolleys with 5% hydrogen
peroxide.
3.

Spray the Dental department with 20% hydrogen peroxide.

4. Change all curtains once in a week.

5. Change linen on examination table every day or as and when required.
6. Remove trash from dustbins and change the trash liner every evening before closing
hours.
7.

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

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

9.

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

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

15

11. Change doctor coat and replace with new coat.

13.0 CLEANING AND DISINFECTION OF DRESSING ROOM

1.
2.
3.
4.

Spray the entire room with 20% hydrogen peroxide daily in the evening.
Clean all the table tops with 5% hydrogen peroxide twice in each shift.
Trolley to be kept clean at all times.
Wipe the top of dressing trolley with 5% hydrogen peroxide.

14.0 CLEANING AND DISINFECTION OF INPATIENT WARDS

1. The cleaning of a patient's wards will be performed once during each shift.
Housekeeping staff with emphasis on patient touch areas such as bed, bed rails, door
knobs, handles, monitoring equipment, buttons/controls, cables.
2. After a patient is discharged all used disposable items like IV bags and tubings,
suction catheters and tubings will be discarded by nurses.
3. Soiled linen is removed by Housekeeping Staff.
4. Clean the bed surface including under the mattress with disinfectant.
5. Toilet cleaning, bathrooms, sinks, showers should be cleaned every six hourly or as
when required. Soap and clean towel would be provided and will be refilled as
needed.

CLEANING SCHEDULE IN WARDS

Cleaning
Areas

Material
Used

Responsibility

Daily

Beds / bed
rails

2% Sodium
Hypochlorite

Housekeepers/General
Duty Attendants

2 times

Bed side
trolleys

2% Sodium
Hypochlorite

Housekeepers/General
Duty Attendants

2 times

Dressing
trolleys

2% Sodium
Hypochlorite

Housekeepers/General
Duty Attendants

Crash carts

2% Sodium
Hypochlorite

Housekeepers/General
Duty Attendants

Cardiac
Table

2% Sodium
Hypochlorite

Housekeepers/General
Duty Attendants

ECG trolley

2% Sodium
Hypochlorite

Housekeepers/General
Duty Attendants

2 times or
as per
reqrmnt
2 times or
as per
requirement
2 times or
as per
requirement
Once

Weekly

Monthly

16

Defibrillator
Trolley

2% Sodium
Hypochlorite

Housekeepers/General
Duty Attendants

Once

IV Stands

2% Sodium
Hypochlorite

Housekeepers/General
Duty Attendants

2 times

Nursing
Stations

2% Sodium
Hypochlorite

Housekeepers/General
Duty Attendants

2 times

Chairs

2% Sodium
Hypochlorite

Housekeepers/General
Duty Attendants

Once

Mops

2% Hypo
bleach

Housekeepers/General
Duty Attendants

3 times

Fans

Wet mop

Housekeepers/General
Duty Attendants

Mirrors

Soap Water
Sol.

Housekeepers/General
Duty Attendants

once
Daily

Cleaning Areas

Material Used

Responsibility

Daily

Frequent touch
area :Switches,
sockets, Door
Knobs, Taps

Disinfectant
solution

Housekeepers/General
Duty Attendants

Three times
a day after
each shift

AC Ducts

Vacuum
Cleaning+Disin
fectant

Housekeeping
supervisor

Dust Bins

Disinfectant
solution

Buckets, Dust
pans

With detergent
powder

Bed side
Urinals/ Bed
pans

Formalin
tablet

Floor

Disinfectant
solution

Chairs

Disinfectant
solution

Lockers

Disinfectant
solution

Sink

Detergent

Housekeepers/General
Duty Attendants

Housekeepers/General
Duty Attendants

Weekly

Monthly

Monthly
once
Twice a
day(morning
+night) at
the end of
shift
3 times a
day
Once a day

Housekeepers/General
Duty Attendants

Housekeepers/General
Duty Attendants

3 times per
shift
Once a day
Once a day
2 times per
shift

17

Fridge

Detergent(insi
de),
Disinfectant
(outside)

Shoe Rack

Wet mop

Housekeepers/General
Duty Attendants

ONCE
OUTSIDE

once INSIDE

Once

PRIVATE WARDS SPRAYING

1. On discharge of patient clear all the furniture from the room.
2. Remove the bed linen, curtains early morning disinfectant for spraying use in sprayer
all over the room.
3. Let it dry.
4. Clean all the table tops, window ledges, all fixtures, phones, chairs and other
furniture in the room with clean duster and 5% disinfectant solution.
5. Floors to be mopped with 1% sodium hypochlorite.
6. Once all the surfaces in the room are dry replace all the furniture back.
IMPORTANT ASPECTS
1.
2.
3.
4.
5.

Do not vigorously shake the cloth to remove the dust while dusting or sweeping.
Change curtains once every week.
Avoid using the patients linen for dusting.
Avoid cleaning mops and dusters in the sinks.
Use clean mops for cleaning.

18

PART -2

CLEANING AND DISINFECTION

OF
NON -PATIENT CARE AREAS

19

(B) NON-PATIENT CARE AREAS

1.0 CLEANING AND DISINFECTION OF CORRIDORS
1. Place wet floor caution signs at both ends of corridor to alert staff and visitors to a
potential risk.
2. Wet mop all corridor, covering only half of the width at time. This allows safe foot
traffic at all times. The patients can walk through the other half of the width and
patient/ relative/ staff falls can be avoided.
3. Wet mop the remaining half of the corridor only when the first half has dried
completely.

2.0 CLEANING DISINFECTION OF TOILETS

1. Wash hands and put on gloves
2. Ventilate the area (for example, open a window), and prepare the cleaning
solution in a well-ventilated area (refer to manufacturers instructions)
3.

Flush the toilet with the seat lid down

4. The toilets should be thoroughly cleaned at least once every shift and mopped
dry. The floor should be made non-slippery and all deposits removed.
5. Apply the cleaning agent to the inside of bowl, including under the rims and
allow to soak and clean the bowl after wards Flush the toilet, rinsing the brush in
flushing water (leave the toilet brush in the bowl)
6.

Remove any splashes or marks from the wall

7. Wipe the toilet seat and flush handle with the cloth, and then close the lid.
8. Dispose of the cloth when the task is completed
9. Remove gloves and wash hands
10. In addition to the stipulated timings, sweeper shall also undertake such
sweeping / cleaning /mopping operation as and when required or as directed by
Housekeeping Supervisor /nursing staff on duty, or such personnel as may be
authorized in this regard by the superintendent at any time of the day and night.
11. The outlets and drain pipes of the urinals should be kept clog free and fixed in
proper place.

20

12. The clogged drain pipes are to be de clogged immediately and drain chambers
cleaned thoroughly once a week as part of preventive maintenance and also one
register to be maintained for all the drainages of the hospital.
13. Regular monitoring to be done by the housekeeping supervisor for the cleaning
by maintaining and filling the checklist.
14. In-case of Indian Toilets: Apply the cleaning agent to the inside of bowl,
including under the rims and allow to soak and clean the bowl after wards Flush
the toilet, rinsing the brush in flushing water. Then clean the foot pedals with
disinfectant and let dry. Cleaning steps would be similar except for the cleaning
of the foot pedals.

2.1 RECORD FOR TOILET CLEANING

DATE

TIME

CLEANING DONE BY

SIGNATURE OF SUPERVISOR

REMARKS

3.0 CLEANING AND DISINFECTION OF LIFT

1. Take the Lift to a non-patient, non-public floor for cleaning and turn off with key.
2. Mix disinfectant detergent in bucket.
3. Clean with damp cloth soaked in disinfectant detergent. Wipe dry to prevent
streaking and replace.
4. Dust mop the floor.

21

PART-3

SPILL MANAGEMENT,
BIOMEDICAL WASTE MANAGEMENT
AND
OTHER PROTOCOLS

22

1.0 GUIDELINES FOR SPILL MANAGEMENT

1.0 SPILL MANAGEMENT OF BLOOD & BODY FLUID
The factors involved in Spill Management are given below:

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

The pathogens most likely to be involved in these different types of spills (e.g.
Stool samples may contain viruses, bacteria or protozoan pathogens whereas
sputum may contain mycobacterium tuberculosis)

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

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

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

The location involved i.e. whether the spill occurs in a contained area such as a
microbiology laboratory or in a waiting area or wards, OPDS.

HAZMAT KIT LIST (HAZARDOUS MATERIAL KIT)

1. Gloves
2. Mask
3. Goggles
4. Disposable Gown
5. Tissue roll
6. Sodium hypochlorite 2%
7. Gum boots
8. Cap
9. Chalk
10. Two Cardboard pieces
11. Syringe
12. Cotton
13. Sulphur Powder
14. Small Glass Jar
15. Instruction Sheet

23

PROCEDURE FOR SPILL MANAGEMENT

1. Wear Personal Protective Equipment (Gloves only in case of minor spill, apron,
mask for major spill, to avoid before cleaning the spillage
2. Cover the area with 1 % hypochlorite and bleaching power, chalk powder to sock
the spillage
3. Leave it for 20 minutes
4. Collect the residue with newspaper or cardboard.
5. Wipe and discard all the waste in disposable bag
6. Disinfect the entire spill area with a hospital-grade disinfectant and allow it to
stand for the amount of time recommended by the manufacturer.
7. Mop the spillage using disposable cloth or wipes until the area is visibly clean
8. Remove the gloves and discard in the same bag ,tie the bag properly and put label
with the type of spillage
9. Wash the hands properly.

10. Fill incident form and submit

NOTE: If spill contain broken glass and there is a risk of sharps injury, first disinfect the spill
with 1% sodium hypochlorite solution and after 20 minutes, put broken glass pieces in the
sharps container and then proceed further to wipe the spill
Steps to follow in case of Mercury spill :
1) Remove all items nearby the mercury spill. Switch off the exhaust fan if on.
2) Wear face mask to prevent inhalation of mercury.
3) Remove the clothes if spoiled with mercury.
4) Remove the ornaments. Wear gloves.
5) In case of sharps of the glass wrap it in the paper and put in the zip bag. This should be
labelled with Contaminated with mercury.
6) If spilled in the wood or tiles can be cleaned easily, but if spilled on linen the portion is to
be cut and removed.
7) Collect the tiny mercury particles with cardboard. Tiny particles can be seen with torch.
For this after switching off the lights in room the torch light is focused along the floor.
Observe the room with such precautions.
8) Collect the particles of mercury with dropper or syringe and then placed in bottle filled
with water. Bottle is to be closed airtight. Place the bottle in the zip lock bag and is to be

24

labelled Contaminated with mercury. After collecting the larger particles if the tiny
particles are not seen then sulphur powder is sprinkled to visualize the tiny particles which
makes the mercury particles darker and can be seen easily. Then small particles are collected
with syringe and placed in bottle.
The precautions are taken to prevent the powder inhalation, which is poisonous.
9) All the equipment used for cleaning including gloves are placed in zip lock bag and
labelled.
10) The zip lock bag is deposited to staff nurse and disposed off as per Biological waste
management rules.
11) The doors and windows of the room where the mercury spilled are to be kept open for
24 hours. In case of mercury side effects immediate medical treatment is provided.

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2.0 BIO-MEDICAL WASTE MANAGEMENT

2.1 BIOMEDICAL WASTE SEGGREGATION CHART

The housekeeping Supervisor has the responsibility of training on BMW.

COLOUR OF BIN

TYPE OF WASTE

ACTION/ ATTENTION

Blood or Body Fluid infected tubings, Blood and Urine

Bags, I/V Sets, Syringes, Catheters,
RED

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

Sheets & McIntosh for patient care, Gloves after
disinfection

Disfigure and disinfect by

soaking in 1% Sodium
Hypochlorite Solution

Human Tissue, Dressings, Gauge, Bandages, POP

Plaster, Cotton Swabs, Dressing Tapes, Discarded
YELLOW

House-Keeping Mops/ Clothes, Bed- sheets &

Disfigure before disposing

Blankets (Blood Soaked)

BLUE

Sharps, Needles after destruction, Broken Glass,

Unbroken Glass Vials/ Bottles/ Ampoules

Disfigure before disposing

Kitchen Waste, Paper, Polythene, Card board,

Aluminum Foil, Disposable Glasses/ Bottles/ Plates,
BLACK

Vegetable & Fruit Peel & Left Over Food

Do not litter the place

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2.2 BIO MEDICAL WASTE MANAGEMENT HANDLING RULES 1998.

Bio Medical waste management is done by appropriate authorities and rules and
regulations are followed regarding Bio Medical Waste Management handling rules
1998.

SCHEDULE A
CATEGORIES OF BIOMEDICAL WASTES:Option

Waste Category

Treatment & Disposal

Category No. 1

Human Anatomical Waste( human tissues organs, body

Incineration @ deep

parts )
Category No. 2

burial*

Animal Waste(animal tissues, organs body parts carcasses

Incineration @ deep

bleeding parts fluid blood and experimental animals used in

burial*

research)
Category No. 3

Microbiology & Biotechnology Waste(wastes from

Local autoclaving /

laboratory cultures, stocks or micro-organisms live or

micro waving

vaccines, human and animal cell culture used in research and

infectious agents from research and industrial laboratories,
wastes from production of biological, toxins, dishes and
devices used for transfer of cultures)
Category No. 4

Waste sharps (needles syringes scalpels blades, glass, etc

may cause puncture and cuts)

Disinfection(chemical
treatment) / autoclaving
/ micro waving

Category No. 5

Discarded Medicines and Cytotoxic drugs ( wastes

incineration@

comprising

destruction And drugs

of

outdated

contaminated

and

discarded

medicines )

disposal

in

secured

landfills
Category No. 6

Category No. 7

Solid waste ( Items contaminated with blood and body fluids

Incineration@

including cotton dressings soiled plaster casts, lines beddings

Autoclaving

other material contaminated with blood )

waving

( Wastes generated from disposable items other than the

Disinfection by chemical

waste sharps such as tubings, catheters, intravenous sets etc

treatment @ autoclaving

micro

micro

waving

Mutilation

and
/

shredding##

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Category No. 8

Liquid waste( waste generated from laboratory and washing

Disinfection by chemical

cleaning housekeeping and disinfecting activities )

Treatment

@@

and

discharge into drains

Category No. 9
Category No. 10

Incineration Ash( ash from incineration of any bio medical

Disposal in municipal

waste )

landfill

Chemical waste( Chemical used in production biological,

Chemical treatment @@

chemicals used disinfection as insecticides etc )

and

discharge

into

drains for liquids landfill

for solids
Chemical treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It must
be ensured that chemical treatment ensures disinfection.
* Mutilation/Shredding must be such so as to prevent unauthorized use.

SCHEDULE B
COLOR CODING AND TYPE OF CONTAINER
FOR DISPOSAL OF BIOMEDICAL WASTE
Color Coding

Type of Container

Waste Category

Treatment as per Schedule I

Yellow

Plastic Bag

Cat.1, Cat. 2, and

Incineration/deep Burial

Cat.3 Cat 6
Red

Disinfected

Container/plastic
Cat.3 Cat.6, Cat.7

bag
Blue/

Plastic bag/ puncture

White

Proof container

Autoclaving Microwaving/Chemical
Treatment

Cat.4, Cat.7

Autoclaving / Microwaving/
Chemical Treatment and

Translucent
Black

Plastic bag

Cat.5, and Cat.9

Disposal in secured landfill

and cat.10
( Solid)
Notes:
1.

Color coding of waste categories with multiple treatment options as defined in Schedule I,
shall be selected depending on treatment option chosen, which shall be as specified in Schedule I.

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2.

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

3.

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

4.

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

SCHEDULE-III
LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS
BIOHAZARD SYMBOL

CYTOTOXIC HAZARD SYMBOL

BIOHAZARD

CYTOTOXIC
HANDLE WITH CARE

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

29

2.3 RECORD FOR MAINTENANCE OF BIOMEDICAL WASTE MANAGEMENT

SR.

DATE

BMW QUANTITY

SIGNATURE

NO.
Yellow

Red

Blue

Quantity in

Quantity

Quantity in

kgs

in kgs

kgs

Total quantity

Housekeeping

kgs.

supervisor

Monthly collection

Annual collection

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3.0 MANAGEMENT OF LOST AND FOUND ITEMS

In order to protect any article inadvertently left or lost by a patient, visitor to the hospital
and it can be deposited safely so that it can be handed back by the housekeeping supervisor a
procedure for Lost and Found is very essential.
DESCRIPTION:
1. When an article is found, finder to immediately report to housekeeping supervisor.
2. The housekeeping supervisor to enter details in his lost & found register
3. A unique S No. Generated form is attached to the item with details of date, name of the
ward room no, location, patient name if found in the room & name of finder.
4. Forwarding address is obtained from IP admission.
5. The housekeeping supervisor may contact the patient to either claim it or for further
instructions.
6. When claim is made, detailed description of the article is verified before handing over.
The claimants signature is taken as acknowledgement on the receipt generated through
lost & found module.
7. If not claimed the article is kept under custody of matron for 6 month. After which time it
is disposed off as decided by hospital authorities.

4.0 MANANGEMENT OF PEST CONTROL

Management of pest Control is vital to eradicate pests like rats, flies, mosquitoes, lizard, ant,
silver fish and termites from hospital premises.
DESCRIPTION:
Pest control is an activity, which is given out on contract to a company specializing in
this field. Their scope of work is as follows
1. Pest control services including all related and connected services such as fly control,
household disinfestations, rodent control measures, vector control, fogging,
fumigation in respect of all the areas as specified by the company meeting best
cleanliness standards and maintaining it at all times. Area covered includes entire
premises and precincts thereof and any other area indicated by the management as
per agreed schedule and specifications.

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2. Starting from one side, all areas have to be sprayed as per terms and conditions
mentioned in the contract (As per MOU).
3. Every evening pest control book to be checked by the pest control in
charge/housekeeping supervisor as per pest control daily schedule.
4. Equipments & chemicals are to be provided by the contractor (As per MOU).
5. Clearance of bill is subject to the pest free premises of entire building as per quality
standards and as per schedule.
6. Any complaint received from area in lodged in a complaint format (as below)

PEST COMPLAINT FORMAT

DATE:
Type of complaint...
Area.....
Complaint given by
Given to
Received time
Time complaint attended.
Measures taken
Housekeeping Supervisor/Pest control supervisor sign
Company supervising.

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5.0 RECORDS TO BE MAINTAINED BY THE HOUSEKEEPING SUPERVISOR

(As per MOU with respective District Hospital)
1) Monthly Indent Register For Disinfectants And Consumables
2) Stock Register For Disinfectants And Consumables
3) Floor Wise/ Area Wise Cleaning And Disinfection Schedule
4) Biomedical Waste Segregation Record
5) Fumigation Record (Separate For Operation Theatre And Wards
6) Incident Record (For Spill Management)
(With Corrective and Preventive Actions)
7) Attendance Register/ Duty Roaster
8) Record Of Housekeepers For Needle Stick Injuries (Duplicate Copy)
9) Training Record
10) Lost And Found Record

6.0

SUGGESTIVE LIST OF EQUIPMENT/GADGETS/MACHINERY FOR

HOUSEKEEPING DEPARTMENT
Indicative list of Equipments/ Gadgets/ Machinery to be used cleaning etc:
1) Dry Vacuum Cleaners
2) Floor Scrubbers cum wet Drier (Walk Behind Type)
3) Biomedical Waste Transportation trolley with Covers
4) Wet Jet Washers
5) Cob Web Remover
6) Floor Mopper (Trolley Mounted)
7) Floor Wiper
8) Glass Clearing Roller
9) Aluminium Ladder for Cleaning Purpose
10) Wheel Barrows

33