AUDIT OF

INFRASTRUCTURE OF
HOSPITAL
Part A
1. Facility provides adequate
illumination level at patient care areas

• Adequate illumination in ward

• Adequate illumination in nursing station

• Adequate illumination in open area at night

• Adequate illumination in circulation area(Stairs,
corridor and waiting area)
• Adequate illumination in toilets
[Link] Area Illumination level

1 General lighting (wards) 100 lux

2 Nursing stations 150-300 lux
3 Night lighting 1 lux
4 Examination light (in ER) 1000 lux
5 Stairs & corridors 100 lux (in evening
1 lux (in night)
6 Reception & Waiting Room 150 lux
7 Casualty & OPD department 150 lux
8 Toilets Atleast 100 lux
2. Facility has security system in place
at patient care areas

• Hospital has in-house/outsourced security system in place

3. Hospital infrastructure is adequately
maintained

• Patient beds are not rusted and are painted.

• Availability of clean and intact bed-sheet &
mattresses
• Window and doors are maintained
• Hospital has system for periodic maintenance of
infrastructure at defined interval
 4. Facility has adequate arrangement
storage and supply for portable water in all
functional areas
Hospital has adequate water storage facility as per requirements
(450-500 Litres per bed per day )
Hospital has adequate water supply from municipal/underground source

All water tanks are kept tightly closed

Periodic cleaning of water tanks carried out (Records ofcleaning is

maintained)
Hospitals periodically tests the quality of water from the source
(municipal supply, bore well etc) for bacterial and chemical content

RO/ Filters are available for potable drinking water

Hospital ensures that the distribution pipelines are not running in

close vicinity of the sewage system.
 5. Facility ensures adequate power backup
in all patient care areas as per load

• Availability of noiseless generators for power back up

• Estimation of power consumption of different department

of hospitals is done

• Generator has adequate capacity to provide 24x7 power

back at least critical areas

• Use of energy efficient bulbs for light

6. Patient care areas are clean and
hygienic

• Adequate Cleanliness in open area

• Adequate Cleanliness in circulation
area(Stairs, corridor and waiting area)
• Adequate Cleanliness in toilets
• Adequate Cleanliness in Indoors
• Adequate Cleanliness in Outdoors
• General waste from hospital is removed
daily by municipal/outsourced agency
 7. Critical areas of the facility ensures
availability of oxygen, medical gases and
vacuum supply
• Oxygen Generation Plant

• Manifold room is located on ground floor

• Manifold room has adequate stock of Oxygen and Nitrogen Cylinders

• Cylinders banks are in duplicate for Emergency

• Alarm system has been provided to indicate any abnormal pressure

change
• There is procedure for prompt replacement of empty cylinders with
filled cylinders (Emergency)
• There is a procedure for periodic checking of all terminal units for
malfunctioning
PART B
 Description Avail Functio Non- Functional Re
[Link] able nal ma
.
Reparable Non-Reparable rk
1 Beds
2 IV stands
3 Bed side locker
4 Attendant Bench
5 Ceiling Fan
6 Air Conditioner
7 Air Cooler
8 Water Cooler
9 RO/Water Filter
10 Wheel Chair
11 Pt Trolley
12 Bed Sheets
13 Generator Set For
Power Supply
 CHECKLIST FOR CLINICAL
LABORATORIES PERFORMING
SAMPLING AND PCR TESTING FOR
COVID-19

PRE-ANALYTICAL REQUIREMENTS
 Triage and Patient reception
Criterion Yes NO
TRIAGE/ SCREENING AREA
There is a dedicated area for screening of
COVID-19 patients located outside the facility;
alternatively this area has a specific entry site
separate from other facility entry sites.
A clinical triage is set for early
identification of patients with acute
respiratory infection (ARI) to prevent the
transmission of pathogens to health care
workers and other patients.
These equipment are present in the Triage
area:
• Screening questionnaire
• Algorithm for triage
• PPEs
• Hand hygiene sanitizer (alcohol rub)
• Infrared thermometer
• Waste bins and access to cleaning/disinfection
Triage area is secured by glass or plexiglass to protect
healthcare workers who perform preliminary screening
from patients to be screened.
Adequate space for triage is ensured.
Medical masks are distributed to all patients to be
screened while waiting for Triage.
Patients with ARI symptoms are immediately moved to an
isolation room away from others.

At least 2m distance is ensured between patients to be

screened.
At least 2m distance is ensured between waiting room
chairs; alternatively back-to-back chairs are set.

Contact and geographic information, history of clinical

symptoms, recent travel, and possible exposure to
suspected or confirmed COVID-19 patients are
collected and filled in the screening questionnaire.

There is clear signage for symptoms and directions.

Triage area is well aerated and regularly cleaned and

disinfected.
 Standard and Additional Precautions
Criterion Yes NO
Laboratory staff are trained for hand and respiratory
hygiene precautions and usage of PPE according to risk.
There is a dedicated area for Donning / Doffing before and
after specimen sampling and handling.
Laboratory staff are familiar with Dressing/ Undressing
phases and sequential steps.
Sequence of Donning PPE is followed: Hand hygiene
applied gown worn à mask/respirator applied à goggles/
face shield worn à first and second pair of gloves worn.
Sequence of Doffing PPE is followed: First pair of gloves
removed à goggles/face shield removed à gown removed à
mask/respirator removed à second pair of gloves removed
à hand hygiene applied.
All used PPEs and paper towels are discarded inside a
waste container (yellow biohazard bag) in the
anteroom if available otherwise on the way to the door.
Written procedures are available for standard and additional
precautions.
 Specimen Sampling
Criterion Yes NO
INPATIENT/ OUTPATIENT SETTING:
For nasopharyngeal or oropharyngeal aspirates
or washes, nasopharyngeal or oropharyngeal
swabs, the healthcare worker uses the following
PPEs: medical mask, eye protection (goggles or
face shield), clean, non-sterile, long-sleeved gown
(+apron) and gloves.
INPATIENT SETTING:
For aerosol-generating procedures (e.g., tracheal
intubation, non-invasive ventilation, tracheostomy,
cardiopulmonary resuscitation, manual ventilation before
intubation, bronchoscopy), the healthcare worker uses the
following PPEs: respirator (N95, FFP2 or equivalent
standard),eye protection (goggles or face shield), clean,
non-sterile, long-sleeved gown (+apron) and double pair of
gloves.
At least the apron and the gloves are changed between
two consecutive patients to be sampled.
Procedures are performed in an adequately ventilated
Room OR negative pressure rooms with at least 12 air
changes per hour OR controlled direction of air flow
when using mechanical ventilation.

A triple packaging ensures specimen protection during

transportation.
The external surface of the transport box is wiped with a
disinfectant and handled to the person assigned for
specimen transportation.
 Biosafety Precautions
Criterion Yes NO
Initial processing of all specimen take place in a validated
class II Biological Safety Cabinet (BSC), e.g. manual opening
of container of respiratory sample, tube vortexing, etc.
Appropriate personal protective equipment (PPEs) are used
when working with clinical specimens.
Double pair of disposable gloves and a respirator (N95, FFP2
or equivalent standard) are used.
Diagnostic laboratory procedures (nucleic acid amplification
tests) follow Biosafety Level 2 (BSL-2) guidelines
implemented by the institution.
Limited number of personnel is allowed to be present in the
Biosafety Level 2 (BSL-2) area.
Technical procedures are performed in a way that minimizes
generation of aerosols and droplets.
The class II Biological Safety Cabinet (BSC) is cleaned after
use with a virucidal detergent-disinfectant as per
manufacturer’s recommendations (in compliance with the
concentration and contact time).
Written procedures are available for all biosafety rules and
technical operations.
TRANSPORT AND
STORAGE CONDITIONS
 Criterion Yes NO
The personnel who transport specimens from suspected or
confirmed COVID-19 patients are trained in safe handling
practices and spill decontamination procedures.
Specimen are labelled and transported as ‘Biological
Substance Category B’.
Specimen from URT (nasopharyngeal and oropharyngeal swabs):
- Collected in VTM (viral transport medium) or Saline
tubes.
- Stored at 2-8°C for up to 5 days (VTM).
- Stored at 2-8°C for up to 72 hours (Saline).
A triple packaging ensures specimen protection during
transportation.
- Primary container: absorbent packaging material,
water-tight and leak-proof
- Secondary container: durable, water-tight and leak-
proof
- ; contains absorbent material (cushions)
-
Outer container : protects contents from physical
damage and water while in transit
When a specimen is received from an external laboratory,
the external surface of the transport box is disinfected.
 STATUS OF
DIAGNOSTIC
[Link]. Name Of Test Available Remark
Yes No
1 RTPCR
2 CBC
3 D-DIMER
4 RBS
5 ECG
6 HBA1C(If Diabetic)
7 X-RAY CHEST
8 S. ELECTROLYTE
9 RFT
10 [Link] ACID
11 LFT
12 CRP
13 [Link]
14 [Link]
15 BLOOD CULTURE
(If Count is Vary High)
16 TROP-I
17 TROP-T
18 PT-INR
19 ABG
20 [Link]
21 S. Mg 2+
22 S. Ca 2+
23 S. Lactate
24 CEP-QUANTITATIVE
25 HRCT

MILD case MODERATE case SEVERE case

1-11 1-19 1-24
 Equipment for Diagnosis:
Description Availabl functio Non- Functional rem
S. e nal ark
No Reparabl Non-
. e Reparable
1 Glucometer
2 CBC machine

3 Biochemistry
analyzer
4 Inflammatory
markers*
5 RTPCR lab

6 X ray machine
ECG machine
7
Echo Machine
8
Ultra Sound
9
10 HRCT
THANKS..!!