Suggested TORs for Outsourced Services

Definition of work area

All open and covered area within the boundary of the Health facility including roof and basement (if any) will be within the scope of housekeeping services to be provided by the contractor it includes all of the Hospital rooms of all the departments, stores,canteen/ kitchen (if not outsourced), consultants chambers, wards, ICUs, Operation Theatres, CSSD, Laundry, Labs, Blood Bank, all corridors and all covered spaces and premises. It does not include cleaning of residential quarters, which are situated within the hospital premises.

Objectives and general rules

1. The main objective of the outsourced service is to provide a high level of a neat, clean, hygienic and presentable look to the entire area. The contracting organisation and their team will supervise the work listed in the TORs.
2. The contracting organisation will ensure that the staffs deployed are dressed in neat and clean uniform, which is approved by the Health Facility.
3. Housekeeping / cleaning services should be provided round the clock on all days including holidays, so that all areas are neat and clean all the time. Working hours should be adjusted in such a manner that cleaning work in the morning should be completed half an hour before the start time of normal work.
4. Apart from housekeeping services as described below, the Housekeeping staff shall also assist the hospital nursing staff in day-to-day patient care such as receiving and dropping patients at the entrance, taking patients to diagnostic /laboratory, sending blood / stool / urine samples to laboratories etc.

Detailed scope of Housekeeping Services include but not limited to the following

1. Schedule of cleaning to be observed by the staff is given in the Appendix ‘I’ to this ToR.
2. Behaviour of contractor & his staff with hospital personnel, patients and visitors would be courteous and respectful. The staff would maintain confidentiality of information, which they may access during the course of their duty in the hospital.
3. Cleaning, scrubbing and disinfecting bathrooms, toilets, wash basins, sanitary fittings, floors etc. of all the areas including Wards, ICUs, OT and all other departments at regular intervals on daily basis.
4. Vacuum cleaning of all carpets and upholstered furniture on weekly basis.
5. Cleaning and disinfecting kidney trays, urinals, bed pans, sputum cup, humidifiers,suction bottles and emptying urine and drain bags whenever required.
6. Cleaning blood spills and others such as human excrement, urine, vomitus,unsterile body fluids as & when required.
7. Cleaning, dusting electrical switch boards, light fixtures, fans, air conditioner vents, name plates, door mats, firefighting equipment, computer systems,phones, doors, windows, furniture, window glasses, grills, curtains etc.
8. Cleaning of dust bins, waste paper baskets, cobwebs etc. and disposing off all collected refuse on daily basis at regular intervals. The dust bins shall be washed and garbage bags need to be placed in all garbage bins to avoid stains and clear them when it is 3/4 full.
9. Collect garbage in specified colour coded bags from all dust bins and garbage bins existing inside the premises and disposed at the designated area within the hospital.
10. Refilling, replacing and emptying of sharp containers at all stations.
11. Offering and assisting the patient with kidney tray, urinals, bed pans, sputum cups when required and disposing the contents in the sluice room, clean,disinfect and keep it ready for next use.
12. Cleaning the patients who have soiled themselves with stool, urine, vomitus with assistance of Patient attendant / nursing orderly / staff nurse / nursing sister.
13. Sluicing linen which are soiled by urine, vomitus, faeces and others with 1% chlorine solution and send to laundry.
14. Spraying room fresheners in all rooms on daily basis at regular intervals.
15. Assist in transporting dead bodies to mortuary and disposal of amputated limbs or other parts to bio medical waste collection point.
16. Assist in fumigation as per schedule.
17. Refilling, replacing and emptying of sharp containers at all stations.
18. Cleaning, mopping, disinfecting OT floors, walls, ceilings / OT lights in morning before starting the case as per instruction & direction of OT In charge.
19. Clean the patients’ bed, lockers, trolleys, wheel chairs and surrounding areas twice a day or when patient is discharged or when soiling occurs.
20. Cleaning and carbolization of ICU beds, OT beds as per instruction.
21. Washing of slippers in ICUs, OT, dialysis etc.
22. Scrubbing / cleaning of toilets, wash basins, sanitary fittings, glasses, toilets,floors etc.
23. All the garbage collected at the designated points spread over the health facility premises as well as the Hospital general waste which does not require incineration should be cleared on daily basis to municipality defined yards outside health facility campus.
24. It is the responsibility of the contractor’s deployed housekeeping staff to clear the choking of sinks, wash basins, floor traps, Rain water pipes, sewer chamber & sewer lines.
25. Cleaning of all open areas between the building and boundary including sweeping of roads, lawns, paths, cleaning open drains, common areas of Residential Buildings, Pump Rooms, Pump House, AC Plants, Electrical Substation, Nurse Hostel, Main gate etc. as directed by the designated nodal officer of the health facility.

Waste Disposal Management (Including Bio-Medical Waste)

The following general instructions will be followed

1. All collection, storage, transportation and disposal of hospital waste shall be in accordance with Bio-Medical Waste (Management and Handling) Rules, 1998 and any other amendments or notification of the state pollution control board.
2. A detailed Hospital Waste Management Plan shall be prepared. The plan would be approved by the nodal officer of the health facility’s authorities before start of work.
3. All infected, chemical, Radiation, Cytotoxic Health care waste shall be segregated,collected, stored, transported and disposed in accordance with set guidelines of safety, ensuring that at no stage it gets mixed with general waste. Unscientific burning shall not be undertaken. Different coloured bags/containers namely red,yellow, black, blue and puncture proof or stainless steel, lead containers shall be used depending on the category of waste.
4. The waste shall be carefully secured or pre -treated for transportation to a common facility for disposal.
5. Waste shall not be transferred from one bag to another. Bags should be tied when three fourths full and then placed in a bigger bag / container for transporting.
6. Covered Trolleys or containers should be used for transportation. Before final disposal/ treatment waste should be kept in specified location and in specific liners and containers.
7. The scope includes segregation, collection, storage, transportation within and outside the Hospital until final disposal. All statutory rules and regulations and legal requirements are to be followed at each stage.

Documentation

The following general requirements and documentation will be followed / maintained.

1. Organisational structure with local supervisor and line of authority with job description of each category of housekeeping staff.
2. Housekeeping manual and all SOP (Standard Operating Procedures).
3. List of equipment deployed at the health facility.
4. On job training and documentation
5. Vaccination record of all staff
6. Maintaining records of the following
1. Weekly duty roster and Attendance
2. Needle stick injuries
3. Amount of biomedical waste going out to outsourced agency
4. Memorandum of understanding
5. Check-list would the displayed in each area of work, as given in Appendix‘II’.
7. Maintaining logs and checklist.
8. Ensure that both male and female staff should be posted in areas like wards,ICUs, Casualty and OPD, CCU & Wards (wherever applicable).
9. Female patients should be attended by female staff only.
10. Immediate replacement of staff on leave.
11. Rotation of staff if required but the staff of critical areas should not be rotated too frequently.

Monitoring and penalties

The work of the housekeeping staff will be monitored on continuous basis. Penalties would be imposed for work which is incomplete / not done. Penalties would be imposed on the housekeeping staff for improper dress or misbehaviour with staff /patients / visitors. Sample check list for the penalty is given Appendix ‘III’.

Schedule of Cleaning Activities

Sample Check-lists

Sample checklist for Pest control activities

Source: Swachhta Abhiyaan Guidelines for Public Health Facilities