Infrastructure checklist for NABH accreditation

Infrastructure checklist for NABH accreditation

      My earlier post on ‘Preparing for NABH accreditation’, mentions broad approach towards accreditation and the post on ‘How not to prepare for accreditation’ lists out the prevention that you must take. Although NABH standards is largely based on processes, hospital’s infrastructure also plays a pivotal role in determining accreditation status for a hospital. The problem here is that it has not been separately or clearly identified in NABH standards book as standards related to infrastructure. Many infrastructural requirements are actually interpreted from standards and are usually checked during assessments. As fulfilling infrastructure requirements may take more effort and longer time to complete, many hospitals may feel the need of having a checklist of infrastructural requirements that they can fulfill while they start to work upon process related requirements.  
After gleaning through NABH standards and observation of various NABH external assessment, I have listed down following infrastructure related requirement, with an objective that hospitals can use it as a checklist for addressing them. Please note that all of these requirements may not be mandatory, but are usually expected in assessments out of interpretation of NABH standards.

1. Legal requirements – Various legal clearances related to building and infrastructure must be in place. These includes,

1. Fire NOC, building occupancy certificate, Lifts and escalators inspection, boilers permit, Diesel storage permit, electrical inspection report, ETP inspection report, DG set certificate etc.
2. Licenses and clearances from AERB for all Radiation areas and radiation equipment
   (Read all legal documents required by a hospital)

1. Requirements related to emergency situation: The intent is to have a facility that provides safety to its occupants in case of any untoward emergency situation such as fire, flood, mob attack etc. Following things should specifically be taken care of,

1. Each area that are occupied by people should have a way for exit in case of emergency situations.
2. Emergency exit (Evacuation) route must be displayed at appropriate locations such as wards, patient rooms, labs, ICU etc.
3. In case of vertical rise building, facility should have provision for evacuation of people from upper floors. This can be done by having a separate staircase to bring people down from upper floors directly outside the building, or
availability of an open space on each floor to temporarily collect people of that floor till the time they are evacuated by external help
4. Firefighting equipment to be available and accessible to each area of building
5. Dedicated emergency illumination system, which comes into effect in case of fire
6. Equipment for transporting bed ridden patients outside the building in case of emergency
7. A safe area earmarked for collection of people in case of emergency situation
8. Specific facility requirement related to probable disaster situation of the area in which hospital is located. (Suggested read: Disaster preparedness checklist for hospitals)

2. Requirements related to handling outside disaster situation: Hospital’s facility must have ability to deal with patients coming in bulk due to any disaster that occurred outside the hospital, such as bus accident, building collapse etc. Some of the provision that should be there in building should be, (Suggested read: Section on handling mass casualty situation under Disaster preparedness checklist for hospitals)

1. An identified area which could easily be prepared for accommodating mass casualty patients
2. A separate earmarked stock of medicines and consummables in a cupboard to be used only in mass casualty situations
3. Medicine and consumable for frequently occurring emergency situation in the area should be kept available. For eg. Anti-snake venom, if snake bite is a common emergency.
3. Access and patient friendliness: The facility should enable access of patient to different areas and be user friendly to them. These include,
1. Signage for directions and names of areas to be displayed at appropriate locations. All signage and displays should be at-least in two languages (English and local) and in addition pictorial signage should be used
2. Display of layout of the facility at all entrances
3. Display of scope of services and services not in scope
4. Display of important information such as timing, visitor policy and general instructions to patients
5. Entire facility should be a no smoking zone
6. Well maintained ambiance
7. Availability of general utility items like adequate seating space, public toilets etc.

4. Patient safety related requirements – It is expected that the facility should be safe for use of patient and staff. Hospitals are also required to conduct facility safety inspection regularly accross the hospital. Some of the general things that are observed under this expectations are,

1. Floors and stairs across the building (and specially in patient areas) should be non-slippery. If required a signage to inform people about the hazard should be displayed
2. Electric installations should be safe. No dangling or naked wires. Rubber mat below all electrical panels to prevent electric shock to person handling the panels
3. The first and last step of staircase should have an identification (eg. a coloured line) to prevent people from accidentally missing it
4. Drinking water should be regularly tested in a water testing lab for potability
5. The corridors and general movement area should be devoid of unnecessary obstacles or anything that could cause accidents
6. The terrace should have border wall to prevent anyone from accidental falling
7. The land of the hospital should walled to prevent unguarded entry of anybody, including animals
8. The outside open area of the hospital should be safe from snakes, pot-holes or any other accidental things
9. CCTV camera should be installed for security reasons and a notice of same should be displayed
10. The water tanks should be cleaned and date of cleaning should be displayed
11. Biomedical waste collection area should be separate, identified and away from general area
12. Road towards emergency should be clear at all times and should have sufficient space for movement of ambulance
13. Hazardous items like diesel, medical gases cylinders, bulk chemicals etc. should have a safe place for storage
14. Crash cart should be available and easily accessible to each patient area, to be used during medical emergency
15. Radiaology and radiation therapy areas must comply with AERB/BARC regulations

5. Disabled friendly related requirements – The facility should be as disabled friendly as possible. Important things that should be considered for this are

1. Disabled friendly toilets is accessible to patients in each area of the hospital. Such toilets should have provisions like, leveled entry, wide door and inside to accommodate wheelchairs, low height commodes, grab bars, anti-slip mats, water jet and emergency alarm
2. Emergency department must be on ground floor and with a separate entrance
3. Railing to hold on stairs (low height and normal height)
4. Ramps or Lifts (sufficient to accommodate wheelchairs and stretchers)
5. Ramps at all areas where there is a step and may be accessed by patient

6. Infection prevention – The facility must be designed in a manner to prevent cross infection between patients. Things that should be taken care of for this are

1. Inter-bed distance in patient’s wards should be about 6ft
2. Accessibility of handwashing basins in each patient areas. Alternatively, hand rub can be made available near each patient’s bed.
3. CSSD should have zoning to separate clean, sterile and general areas
4. Operation Theatre should have zoning and engineering controls. The infrastructure requirements related to OT are important and has been described in detail by NABH. Please follow this link to access the same.

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