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

	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

	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:

Yes No Out Sourced Other
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

Yes No
Manpower

Yes No
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

Yes No
Containment measures

Yes No
Risk mitigation plans

Yes No
Written policies and procedures are written for infection control practices.

Yes No
Microbiology culture facility availability

Yes No
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 :

Yes No
To following Staff

Doctors Nurses Housekeeping Administration Patient Patient relatives/visitors
Frequency of training (Staff category Frequency of training)
Who basic facility survey

Yes No Other
• 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

Yes No
PPE

Yes No
CAUTI

Yes No
CLABSI

Yes No
VAP/VAE

Yes No
Vaccination

Yes No
Injection safety

Yes No
Isolation precaution

Yes No
Barrier Nursing

Yes No
Environmental cleaning

Yes No
Device reprocessing

Yes No
System alert MDRO

Yes No
C.difficile

Yes No
SSI

Yes No
Authorised by (Signing authority )

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