Hospital profile for Infection control activities

Hospital profile for Infection control activities
Section one: Facility demographics
Name of Hospital
Address & Location of Hospital with Pin code
Contact person Name
Contact person Email
Contact person phone number
Number of beds
Number of ICU beds

Type of facility - Government

Rows	Government
Primary level: PHC or equivalent
Secondary level: CHC or equivalent
Tertiary level: District hospital Teaching Hospitals
PSU
ESIS
Central government/state government/PPP model
Other

Type of facility - Private

Rows	Private
Nursing Home (0-100 beds)
Speciality hospital (0-100 beds)
Multispeciality hospitals
Singly owned/ group ownership/ corporate set up/ trust hospital
Other

Specialities available (Medical )
ICU
OT – Mention number of OT
Speciality OT
Super speciality OT
CSSD
Dialysis:Number of Beds
Daycare
Transplant
PICU Beds
NICU Beds
Wards
General Beds
Special Beds
Twin sharing Beds
Isolation rooms Beds
Emergency Beds
Blood banks
Laboratory services
Microbiology services in laboratory:

YesNoOut SourcedOther
Radiology services
Any other services: Please mention below
Section 2: Basic details of infection control practices
Facility provides budget and manpower for infection control program
Budget

YesNo
Manpower

YesNo
Personnel given responsibility of infection control is expert/trained in infection control. (if multiple people are there, then please mention of chairperson/convener)
Personnel 1: Mention all qualification:
Personnel 2: Mention all qualification:
Updation of annual program Mention frequency
Mention whether following topics are covered: Yes/NO
Risk of infection

YesNo
Containment measures

YesNo
Risk mitigation plans

YesNo
Written policies and procedures are written for infection control practices.

YesNo
Microbiology culture facility availability

YesNo
If yes Facility where outsourced:
Whether accreditated or not: If yes, Mention accreditations and scope. (attach copy)

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Consultant Microbiologist available or not: If yes, Mention highest qualification:
Infection control education is given :

YesNo
To following Staff

DoctorsNursesHousekeepingAdministrationPatientPatient relatives/visitors
Frequency of training (Staff category Frequency of training)
Who basic facility survey

YesNoOther
• Water –
quality,
quantity
facilities and access to water
• Excreta disposal
• Waste water disposal
• Healthcare waste disposal
• Cleaning and laundry
• Food storage and preparation
• Building design, construction and management
•Control of vector borne diseases
Information and hygiene promotion
Element based survey for infection control
Hand hygiene

YesNo
PPE

YesNo
CAUTI

YesNo
CLABSI

YesNo
VAP/VAE

YesNo
Vaccination

YesNo
Injection safety

YesNo
Isolation precaution

YesNo
Barrier Nursing

YesNo
Environmental cleaning

YesNo
Device reprocessing

YesNo
System alert MDRO

YesNo
C.difficile

YesNo
SSI

YesNo
Authorised by (Signing authority )

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