Hospital Standards for Accreditation for Afghanistan

Section 5: Administration and Management

Maintenance of Hospital Facilities

and Equipment
 Hospital Standards for Accreditation for Afghanistan:
Assessment of Progress in Achieving the Standards

Hospital Department or Area: Maintenance of Hospital Facilities and Equipment

Hospital Facility: __________________________________________

Assessor: __________________________________________ Date of assessment: ____________________

Maintenance of Hospital Facilities and Equipment

Compliance in
Basis for Evaluation Score/
Standard
Standard Criteria for Verification of Meeting Meeting Standard Comments/Action Plan
Number Standard (Score)
Full Partial None
2 1 0
(Circle appropriate score)
1 Existence of Hospital Verify that:
Maintenance Plan: • The building appears in good shape 2 1 0
The hospital has a • There is not a lot of inoperable equipment
maintenance plan in the hospital 2 1 0
• Electrical, water and waste system works 2 1 0
2 Existence of Hospital Verify whether:
Maintenance Systems: • The maintenance and repair manual for
The maintenance and hospital equipment are maintained in one
repair manuals for place in the hospital
hospital equipment are
in one location. 2 1 0
3 Existence of Hospital Verify whether:
Maintenance Systems: • There is an inventory of all equipment
There is a master room by room or department by
record of maintenance department 2 1 0
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 Maintenance of Hospital Facilities and Equipment
Compliance in
Basis for Evaluation Score/
Standard
Standard Criteria for Verification of Meeting Meeting Standard Comments/Action Plan
Number Standard (Score)
Full Partial None
2 1 0
(Circle appropriate score)
for each piece of • For each piece of equipment there is a
equipment in the master record of maintenance performed l
hospital 2 1 0
4 Existence of Hospital Verify whether:
Maintenance Systems: • Action record that details when regular
There is an action maintenance is being performed each
record that details the month for all equipment
scheduled maintenance 2 1 0
to be performed for • For each month, there is a schedule of the
each piece of maintenance that is to be performed for
equipment on a regular that particular month
basis or schedule 2 1 0
5 Existence of Hospital Verify whether:
Maintenance Systems: • There are reports that show the state of
There is a system of equipment when tests are administered
reports to show the and if further action is required
state of each piece of
equipment at the time
of each test and to
initiate any further
action which may be
necessary 2 1 0
6 Electrical Systems Verify whether:
Maintenance Tasks • Routine inspection of electrical systems
are Identified and occurs 2 1 0

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 Maintenance of Hospital Facilities and Equipment
Compliance in
Basis for Evaluation Score/
Standard
Standard Criteria for Verification of Meeting Meeting Standard Comments/Action Plan
Number Standard (Score)
Full Partial None
2 1 0
(Circle appropriate score)
Performed: There are • Replacement of defective parts that are
routine inspections, identified 2 1 0
oiling and replacement • There is an annual plan for inspection and
of defective parts for replacement of defective parts
electrical systems. 2 1 0
7 Electrical Systems Verify whether:
Maintenance Tasks • Routine inspection of mechanical systems
are Identified and occurs 2 1 0
Performed: There are • Replacement of defective parts that are
routine inspections, identified 2 1 0
oiling and replacement • There is an annual plan for inspection and
of defective parts for replacement of defective parts
mechanical systems. 2 1 0
8 Plumbing and Water Verify whether:
Systems Maintenance • Routine inspection of plumbing and water
Tasks are Identified systems occurs 2 1 0
and Performed: There • Replacement of worn washers and
are routine inspections, defective plugs
of plumbing and water • There is an annual plan for inspection and
systems. replacement of defective parts. 2 1 0
9 There is Renovation Verify the existence of:
of the Facility— • Required renovations on the outside of the
interior and exterior building have been performed recently
of buildings when and appear sound when inspected 2 1 0
required: Renovations • Required renovations on the interior of the
2 1 0
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 Maintenance of Hospital Facilities and Equipment
Compliance in
Basis for Evaluation Score/
Standard
Standard Criteria for Verification of Meeting Meeting Standard Comments/Action Plan
Number Standard (Score)
Full Partial None
2 1 0
(Circle appropriate score)
are performed when building have been performed recently
required on the external and appear sound when inspected
and inside of the • Renovations include: 2 1 0
buildings when o Painting and washing down
required o Road and pathways repaired
o Drainage and sewage work performed
o Roof and gutter maintenance
performed
o Pointing of brickwork and stone work
o Floors finished
o Electrical rewiring
o Other: replacement of sinks, shelves,
windows and doors
10 There is Renovation Verify whether:
of the Facility— • Equipment deemed irreparable has been 2 1 0
interior and exterior removed from the hospital and is not
of buildings when disposed of on the hospital grounds
required: There is
removal of equipment
that is no longer
operable or repairable
11 Hospital grounds and Verify the:
environment are • Cleanliness of hospital wards 2 1 0
clean: The hospital • Cleanliness of hospital corridors 2 1 0
grounds and facility • The grounds are free of litter and there is 2 1 0

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 Maintenance of Hospital Facilities and Equipment
Compliance in
Basis for Evaluation Score/
Standard
Standard Criteria for Verification of Meeting Meeting Standard Comments/Action Plan
Number Standard (Score)
Full Partial None
2 1 0
(Circle appropriate score)
clean and free of litter no discarded hospital equipment
• Toilet blocks are clean and plumbing is in
order 2 1 0

Row Scoring compliance with the standards

A Total Score (sum total checks for full, partial and no compliance)
B Score for each category (Full compliance =2, Partial compliance =1 and
Non-compliance =0) 2 1 0
C Score of Full, Partial and Non-compliance (Multiply Row A times
Row B)
D TOTAL: Sum of scores for Full, Partial and Non-compliance—(Add all
three columns in Row C)
E Score possible (Total criteria times 2—less any N/A) 50 Total criteria 25 x 2 pts =
maximum 50 point s
F Percentage Compliance with these standards (Divide Row D by Row E) %
possible (less any N/A)

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