Journal of Pharmaceutical Research International
33(37A): 138-144, 2021; Article no.JPRI.71213
ISSN: 2456-9119
(Past name: British Journal of Pharmaceutical Research, Past ISSN: 2231-2919,
NLM ID: 101631759)
Assessment of Services at Tertiary Care Hospital
Located in Central India, using ‘Kayakalp Initiative
Tool’
Neelam Vinod Motwani1, Abhishek Joshi1*, Sonali G. Choudhari1
and Abhay M. Gaidhane1
1
Department of Community Medicine, School of Epidemiology & Public Health, Jawaharlal Nehru
Medical College, Datta Meghe Institute of Medical Sciences, India.
.
Authors’ contributions
This work was carried out in collaboration among all authors. All authors read and approved the final
manuscript.
Article Information
DOI: 10.9734/JPRI/2021/v33i37A31989
Editor(s):
(1) Dr. Jongwha Chang, University of Texas, College of Pharmacy, USA.
Reviewers:
(1) Shamila Hamid, Sher E Kashmir Institute of Medical Sciences (SKIMS), India.
(2) Namir Al-Tawil, Hawler Medical University, Iraq.
Complete Peer review History: https://www.sdiarticle4.com/review-history/71213
Study Protocol
Received 05 May 2021
Accepted 10 July 2021
Published 15 July 2021
ABSTRACT
Background: Kayakalp is an innovative initiatory started by the Health and Family Welfare Ministry
th
through Swachh Bharat Abhiyan campaign on 15 May 2015. These instructions concentrate on
advancement of desirable schemes for housekeeping facilities, pest control procedure, water
sanitation, appointment & tutoring of manpower, advancement and accomplishment of appropriate
cleansing procedure in terms of protocols / Standard Operating Procedures (SOPs), powerful
management and inspection by the employees and inherent Machinery in the treaties linked with
an organizational framework which places a bonus on excellent cleaning services and sanitary
facilities. This study aims to describe the experiences and knowledge based on assessment of
Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha District using this tool.
Objectives: To assess and document hospital upkeep, Sanitation, Hygiene Practices, Hygiene
Promotion and to study Handling of Biomedical Waste, Infection Control and Hospital Support
Services.
Methodology: This cross sectional hospital based study that will be conducted at Acharya Vinoba
Bhave Rural Hospital, Sawangi (Meghe), Wardha District.
_____________________________________________________________________________________________________
*Corresponding author: E-mail: abhishekhunjoshi@yahoo.com;
Motwani et al.; JPRI, 33(37A): 138-144, 2021; Article no.JPRI.71213
Apart from observation of various practices and Processes, the participants to be interviewed will
be Nursing staff in-charge in different wards along with Biomedical engineers, Administrative
officers and beneficiary patients. For Quantitative data collection, a kayakalp checklist will be used.
Data will be collected through observation, staff interview, record keeping, and patient interview
forms as per Kayakalp Initiative Tool.
Results: This study would help to understand current hospital sanitation procedures, hospital
hygiene, infection prevention, general maintenance, waste management, and support services, etc.
and will help to improve services based on findings of the study so as to improve satisfaction of
population catered by hospital and provide an ideal working environment for all stakeholders.
Conclusion: This work will assist in improving hospital/facility management and will aid in
improvement of sanitation and hygiene practices, it will also improve overall satisfaction of all
stakeholders after due implementation of changes suggested at the end of study.
Keywords: Kayakalp; facilities management; hospital hygiene; swachh bharat abhiyaan.
1. INTRODUCTION
1.1 Background
Healthcare institution is an organization where
health services are utilized by people of diverse
age, gender, socioeconomic status, and
ethnicity. ‘Kayakalp’ initiative, a component of
Swachh Bharat Abhiyan movement, was
launched by the Ministry of Health and Family
th
Welfare on 15 May 2015. These guidelines are
categorised as follows into six separate themes:
Healthcare facility maintenance, Sanitizing and
cleanliness, Dumping of waste, Disease
prevention, Hospital assist facilities, and Sanitary
encouragement.
This initiative aims to boost the functioning of
public healthcare facilities [1]. Such regulations
concentrate on reinforcing and streamlining
certain areas like infrastructure management,
improvement
of
appropriate
rules
for
maintenance
department,
pest-controlling
measurements,
waste
water
purification,
workforce distribution & training, improvement
and application of proper cleaning process by
means of rules / Standard Operating Procedures,
appropriate organizational supervision and
control and in-built contract processes combined
with an organizational framework that places a
premium on good housekeeping and sanitation
[2].
‘Regulations for the formulation of Kayakalp’
have been introduced as a tool for
implementation and as a document for seeking
solutions to the problems found. These
recommendations are intended to fulfil the Indian
Public Health Standards (IPHS) guidelines for
secondary health care facilities. However these
can be used on the some discretion for primary
healthcare centers and tertiary care facilities as
well.
This instructions have been established following
a thorough documentary research of the ongoing
leading exercises into the field of medical centre
sanitization, cleaning services, disease control,
overall maintenance, management of waste, and
supportive services etc.; and related excerpts
from the similar was adjusted with appropriate
amendments in accordance with the demands of
government health facilities. These policy
guidelines are universal in character and could
be accepted by the medical institution wisely
according to their extent of the services [2].
Kayakalp Yojana, if once implemented it causes
effective infection control within the facility
leading to better heath outcome [3]. Medical
treatment related diseases, or hospital acquired
infections surroundings are the commonest side
effect in delivery of health care globally. Several
hundred millions of people suffering are impacted
by hospital acquired infections globally year after
year, resulting to great fatality and economic
harm for healthcare system [4]. In the developing
nations, the extent of the difficulties remain
undervalued or even unidentified mostly due to
hospital
acquired
infection
detection
is
complicated and monitoring activity to lead
treatment needs skill and funding [5].
Under the term KAYAKALP, the facilities for safe
supply of water, cleanliness, medical care waste
handling, sanitary and environment purifying
substructure, are ensured in a hospital. ‘Health
care facilities’ encompass total officially
accredited institutions that delivers medical
treatment, comprising primary (dispensaries and
health centres), secondary, and tertiary (district
or public-sector hospitals), general and
independent
(comprising
faith-run),
and
provisional infrastructure built for urgent
conditions (e.g., cholera treating facilities). They
may be situated in metro cities or villages [6].
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Motwani et al.; JPRI, 33(37A): 138-144, 2021; Article no.JPRI.71213
1.2 Rationale
Assessment using Kayakalp tool is first of its kind
holistic assessment of hospital and will provide
valuable insights so as to improve the services of
hospital in terms of health care management,
sanitization and cleanliness, disposal of waste,
disease prevention, health care services, and
encouragement for cleanliness. As assessment
using kayakalp initiative tool has not been
conducted in our tertiary care hospital till date.
‘Cleanliness and hygiene’ in health care facilities
not only plays an important role for disease
prevention but also additionally promotes
mouldable behavioural patterns amongst the
patients and visitors regarding hygiene and
sanitization at their own houses and workstation.
Kayakalp is a powerful tool of unbiased
evaluating and assisting the transition of
entry/procedure with the anticipated results and
effects with excellence finally verified by the
patient experiences. Considering this, the
proposed study is planned to assess services at
tertiary care hospital, in central India.
supported by the advanced diagnostic, imaging
and therapeutic, facilities such as Colour
Doppler, Computerised Tomography scan, MRI,
Central Clinical Laboratory, super speciality
services like Knee Transplantation, Angioplasty,
Test tube baby centre ,..etc. Moreover the
hospital is resourced with a state-of-art operation
theatre connected Intensive Care Unit, Intensive
Critical Care Unit, Paediatrics Intensive Care
Unit. The hospital has a hospital infection control
committee and biomedical waste management
board.
2.3 Study Participants
The study participants will be key administrative
staff of hospital, in-charges of various facilities
and other stakeholders as per Kayakalp initiative
tool like staff nurse in charge of different wards
along with biomedical engineers, administrative
officers and patients in AVBRH , Sawangi
(Meghe), Wardha District.
2.4 Study Size
To assess various services provided by tertiary
care hospital using Kayakalp initiative tool.
The study that will be conducted among sister incharge in 49 different wards, 15 OPDs along with
2 biomedical engineers, 6 administrative officers,
1 sanitary inspector and patients. A total of
around 140 stakeholders will be interviewed.
1.4 Objectives
2.5 Variables
1.3 Aim
1. To assess and document hospital upkeep
& sanitation, hygiene practices and
hygiene promotion.
2. To assess handling of biomedical waste &
infection control and hospital support
services.
3. To suggest the measures for improvement
of services based on the study findings.
2. METHODOLOGY
1. Knowledge and attitude of infection control,
hygiene promotion, support Services
2. Practice and compliance of hospital
upkeep, waste management, hygiene
Promotion
Study Duration: One year.
2.6 Selection Criteria for Subjects under
Study
2.6.1 Inclusion criteria
2.1 Study Design
This study will be a hospital based cross
sectional study.
2.2 Study Setting
The study will be conducted in Acharya Vinoba
Bhave Rural Hospital (AVBRH), at Wardha
district of Maharashtra state. The hospital is a
1525 bedded completely equipped tertiary health
care hospital attached to a medical teaching
institute and located in central India.
It is
140
All concerned stakeholders like Chief
Medical
Superintendent,
Nursing
Incharges of respective wards, Biomedical
Engineers, Sanitary Inspectors, Civil
Engineers, Administrative incharge of the
respective departments and patients
randomly chosen from each wards will be
included.
Study participants who gave consent for
participation in study will be included in this
study.
Motwani et al.; JPRI, 33(37A): 138-144, 2021; Article no.JPRI.71213
2.6.2 Data collection tools and procedure
2.6.4 Analysis plan
For quantitative data collection, a pre-designed
and pre-structured questionnaire of Kayakalp
initiative tool will be used. This data collection
tool will be translated into vernacular language
(Marathi) and after retranslation it will be
validated with the help of language experts. Data
collection tool consists of the various heads like
Healthcare facility maintenance, Sanitization and
cleanliness, Dumping of waste, Disease
prevention, Hospital assist facilities, Sanitary
Encouragement
An assessment protocol and scoring system for
kayakalp includes 3 categories i.e. thematic area,
Criteria and Checkpoint.
The thematic area includes broader aspect of
Swachhata, called as pillars of Kayakalp namely,
A- Healthcare facility maintenance
B- Sanitizing and cleanliness
C- Dumping of waste
D- Disease prevention
E- Hospital assist facilities
F- Sanitary encouragement
2.6.3 Data sources/ measurement
Later the respective heads/incharges of
hospital, wards, ICUs, biomedical waste
management unit, etc will be approached
for assessment based on Kayakalp tool.
Four assessment modalities will be used as
follows:
1. Direct
Observation
(DB):
–
This
information
is
gathered
through
observation. Various parameters that will
be assessed by the principal investigator
through
observation
are
level
of
cleanliness,
display
of
protocols,
landscaping, signage etc.
2. Staff Interview (SI): - Information will be
obtained by interaction with concerned
staff to assess their knowledge and current
practices being followed by them, their
competencies
regarding
various
essential skills (like wearing gloves, handwashing,
following
aseptic
precautions,..etc) by direct interview
method. In addition, self-administered
Kayakalp assessment tool will also be
provided to them.
3. Review of records and documentation
(RRD): - Where information can be
obtained from the records available at the
facility. Ex: Availability of housekeeping
checklist, BMW management registers,
culture report for microbial surveillance,
and meetings of Infection Control
Committee (ICC) will be ascertained from
appropriate authorities.
4. Patient Interview (PI): - Interaction /
discussion / interview with either patients
or their attendees will be carried out to
determine their satisfaction on quality of
health care services rendered and overall
hygiene at hospital.
2.6.5 Criteria
There are fixed number of criteria that have
specific attributes in respect to individual themes.
2.6.6 Checkpoint
It in the lowest and most tangible unit of
assessment. A score is awarded by assessors
on checkpoints into specific requirements in the
facility. Each checkpoint has a unique criteria.
After check list tool is completed it will be
assessed by using following parameters.
Complete adherence = 2 points,
Incomplete adherence = 1 point;
No adherence = 0 point
2.7 Bias
1. Kayakalp assessment tool will be a selfadministered questionnaire to be provided
to concerned stakeholders working in
hospital. For many questions/parameters
the respondent might need to recall
leading to a chance of recall bias.
2. In an interview based data collection
amongst the hospital staff and patients,
there
may
be
a
chance
of
Interviewer/variance bias which results
from holding preconceived judgement
about
interviewee,
consciously
or
unconsciously.
2.8 Statistical Methods
The quantitative data will be entered in
spreadsheet. Frequency distribution, percentage,
total score will be calculated and inference will be
derived as per Kayakalp checklist tool. The
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Motwani et al.; JPRI, 33(37A): 138-144, 2021; Article no.JPRI.71213
qualitative data will be transcribed, coded,
categorised into themes and analysed.
3. RESULTS
This study will help to get an insight about
existing practices in the field of hospital
sanitation, hospital upkeep, infection control,
general maintenance, waste management, and
support services etc. It will also help to improve
services based on findings of the study, increase
satisfaction of population catered by hospital and
provide an ideal working environment for all
stakeholders.
4. DISCUSSION
A number of research studies related to health
centre or hospital assessment were reviewed.
Mahendra Chouksey et al (2019) in its study
assessed the sanitation & hygiene on the basis
of Kayakalp tools in tertiary care hospital of G. R.
Medical College, Gwalior, MP and found that the
sanitation and hygiene Practices in the hospital
were not satisfactory. As the first health care idea
is ‘to do no harm’, it is crucial that our health-care
institutions are safe for the hospital staff and
patients and it guarantee compliance with
infection prevention standards [3]. Study
conducted by Omair Anwar et al. (2013),
assessed
of Control of Patients Waste in
Hospitals for the public and private sector of
Faisalabad City, Pakistan (Allied hospital, DHQ
hospital, National security hospital, Aziz Fatima
hospital, Main trust hospital, Gulam- Abad
hospital, Cardiology centres, Faisal hospital.)
found that 71.5% of the Participants had no
experience of garbage recycle . In Pakistan,
Environmental
Protection
Agency
(EPA)
developed their own laws for the correct
biomedical waste management. EPA Sent their
regulations and noted their laws and regulations
to every hospital. But the data above showed
that Respondents were unaware of the
environmental protection act, it demonstrates
that such a condition may be detrimental to the
environment [7]. An Observational Study
conducted on 2016 by Parvathy T Somaiah,
Shivaraj B Mallappa on A Report on needs
assessment of Procedures to manage infections
at a district hospital in southern India, using
Kayakalp tool (Approaches in the District
Hospital using the Kayakalp Tool for Evaluation.)
Found that Workers in the hospitals were not
sufficiently aware of the management and control
of spills. Separation and barrier nursing were well
established in the atmosphere of the facility. The
infection control program was implemented in the
facility, but the same surveillance was not
appropriate. There were no Hospital Acquired
monitoring works or programs in the hospital
[8,9]. Few of the related studies addressed the
burden [10-12] and the needs of appropriate
management tools [13-15] in healthcare sector
[16-19].
5. CONCLUSION
This work will assist in improving hospital/facility
management and will aid in improvement of
sanitation and hygiene practices, it will also
improve overall satisfaction of all stakeholders
after due implementation of changes suggested
at the end of study.
6. LIMITATIONS
Since the study is planned to be conducted only
at one tertiary care hospital findings shall be
applicable to this institute only with limited
external validity/ generalizability for findings.
DISCLAIMER
The products used for this research are
commonly and predominantly use products in our
area of research and country. There is absolutely
no conflict of interest between the authors and
producers of the products because we do not
intend to use these products as an avenue for
any litigation but for the advancement of
knowledge. Also, the research was not funded by
the producing company rather it was funded by
personal efforts of the authors.
CONSENT
As per international standard or university
standard, patient’s written consent has been
collected
and
preserved
by
the
author(s).
ETHICAL APPROVAL
The approval has been obtained from
the Institutional Ethical Committee, followed
by
the
permission
of
Chief
Medical
Superintendent.
COMPETING INTERESTS
Authors have
interests exist.
142
declared
that
no
competing
Motwani et al.; JPRI, 33(37A): 138-144, 2021; Article no.JPRI.71213
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