GOVERNMENT OF PUNJAB

GUIDELINES AND CHECKLISTS

HECKLISTS
FOR
ESTABLISHING & OPERATIONALISING
COVID CARE ISOLATION CENTRES

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 Draft Guidelines and Checklists for Establishing and
Operationalizing COVID Care Isolation Centers

Table of Content
S.no Description Page no.

1. Introduction 3

2. Protocol: COVID-19 Case Management for the State of 3

Punjab

2.1 Flowchart of Patient Management System at CCIC 4

2.2 Workflow for COVID Care Isolation Center (CCIC) 5

3. Human Resource Requirements 6

4. Movement Protocols at the CCIC 7

5. List of Checklists 8

I. Facility Infrastructure 10

II. Waiting Area/Triage 12

III. Reception/Registration 13

IV. Medical Supplies 14

V Laboratory Facility 19

VI Throat Swab Collection (COVID-19, Rapid Test) 21

VII Isolation Room Facility for Patients 22

VIII Room Facility for doctors and Staff 24

IX Infection Prevention and Control Practices 25

X Environmental Cleaning 25

XI Biomedical Waste Management(BMW) 26

XII Other waste Management 26

XIII Trainings conducted for staff deployed 27

6. Annexures(A, B,C,D,E) 27

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ANNEXURE A Covid-19 :GoI Guidelines on Dead Body Management

ANNEXURE B PPE Requirement for 20,000 Beds in the State and Availibility of
Medical Staff on the Portal of Department of Health

ANNEXURE C Protocol for Handling Laundry and equipment and material

requirement for laundries at CCICs

ANNEXURE D - Protocol for Cleaning of Washroom/Other Spaces at the CCIC

- List of equipment and consumables required for cleaning
ANNEXURE E Protocol for Bio Medical Waste Management

Abbreviations :

CCIC: COVID Care Isolation Centre

ICU: Intensive Care Unit
HDU: High Dependency Unit
BLS: Basic Life Support
ALS: Advanced Life Support
HMIS: Health Management Information System
CWTF: Common Waste Treatment Facility
BMW :Bio Medical Waste
HR : Human Resource

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1. INTRODUCTION

The Coronavirus outbreak which started in December 2019 in Wuhan, China has been
declared a pandemic by The World Health Organisation (WHO). To combat this
pandemic, WHO and several national and international agencies such as the National
Center for Disease Control (India), European Centre for Disease Prevention and
Control, U.S. Department of Health and Human Services, and other European and
American institutes, have put forth several operational considerations for case
management of COVID 19 in health facilities and communities. This document
contains some of the checklists pooled together to be particularly useful for
health administrators and decision-makers to gather resources and ensure
preparedness to handle this crisis, the sole purpose of the document is to make
checklists related suggestions regarding the establishment of COVID Care
Centers in the state of Punjab.

Punjab Government has decided to set up COVID Care Isolation Centers (CCICs) as a
state-operated isolation facility for positive cases for constant monitoring by trained
health professionals COVID patients with very mild symptoms are proposed to be kept
in these centers. The total capacity of CCICs would be 20,000 with each having
preferablycapacity of 500-1000 beds. The Ayurvedic university/colleges/big educational
institutes etc. are being identified for this purpose.

2. PROTOCOL:COVID- 19 CASE MANAGEMENT

 The COVID patients can be categorized into three groups:

 Level I are the patients having very mild symptoms, such patients are to
be admitted to COVID Care Isolation Center facilities
 Level IIare the patients with mild to moderate symptoms, they are to be
treatedat District Hospital/ Government Isolation Facilities
 Level IIIare the patients who are in critical condition andare to be referred
to ICU/HDU/Ventilator Facilities.

 The Level I facilities shall be triggered once 70% of the capacity of Level II
facility stands exhausted. However, if the patient graduates from very mild to
mild symptoms s/he shall be shifted to Level II. In critical condition shall further
be sent to Level III facilities .

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  Minimal transfers should be done to prevent the spread. Whenever there is
transfer HR is exposed.
 Only when the sample has been found positive, the patient should be brought to
the CCIC to be kept under constant observation by trained health care
professionals.

2.1 Flow Chart of Patient Management System at CCIC

Step 1: Arrival

Step 2: Triage/Waiting Area

Step 3: Registration

Step 4: Assessment and DiagnosisGeneration

Step 5: Counselling

Sent Home Level I

(Follow Up) Retained at
CCIC

Step 6: Level II
Recovered
Recover/Referral Sent to District Hospital
(Tested – ve, twice)
(Health Isolation
Monitoring)

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2.2 The workflow of COVID Care Isolation Centre (CCIC)

Step 1 - (Arrival):

 The patient who has tested positive and in stable conditionwithout or with
mild symptoms will be admitted at the CCIC.

Step 2 (Triage/Waiting area):

 A volunteer properly attiredas per the protocol shall attend to the patient at
the entrance.
 The patient shall be provided with the hand sanitizer and disposable triple-
layermask.

Step 3 (Registration):

 The patient’s details are noted by the data entry

operator/nurse/paramedical staff who will wear the PPE kit and write down
all the details.
 Patient details shall include their contact details, address, ID generation
and generation of file.Details of emergency contact as well as
people/institutions/societies, etc. that one has contacted during this period.

Step 4 (Assessment and Diagnosis Generation):

 The patient is then referred to the doctor for a medical examination. The
case history should be made online through the Health Management
Information System (HMIS) and hard copy so that when the doctor
receives the patient, s/he is aware of their case history.
 A paramedical staff should ideally be present to assist the doctor for these
purposes. The doctor can also record the diagnosis as well as the
treatment plan in the HMIS which will be used further.
 Identification and Segregation of high risk patient(co-morbid conditions)
and color coded tagging (wrist bands) shall be done at this stage

Step 5 (Counselling Support):

 There shall be a special focus on the mental health of the patients, to

speedenup their recovery process.
 The counselor will help the patients clarify their doubts and also to offer
moral and emotional support. Their diagnosis needs to be noted in such a
way that follow up calls can be planned.

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  Patient may be guided to use 104 helpline number for further counseling
and any queries after leaving the CCIC.

Step 6 (Recovery/ Referral):

 Each patient under stable/mild condition is to be kept in mandatory isolation

of 14 days at CCIC initially with constant monitoring of their health
 Post 14 days of having tested positive, another COVID-19 test is to be
conducted. If the patient tests negative twice in two daysinterval,s/he will be
considered to be recovered and sent home after Counselling
 If the patient’s condition deteriorates to mild/moderate or
critical,arrangements will be made for their immediate transfer to district
hospital isolation facility/Level II or Tertiary care/ Level III facility
respectively.

Step 7 (In Case of Death):

 The protocol prescribed by Government of India, Ministry of Health and

Family Welfare under COVID-19 GUIDELINES ON DEAD BODY
MANAGEMENT shall be adhered to. The sameare attached herewith
asANNEXURE A

3. HUMAN RESOURCE REQUIREMENTS

The norms for deployment of human resource at the CCICs have been prescribed
as per discussions of the Committee with the Department of Health, Government of
Punjab.It is clarified that deployment of all medical as well as paramedical staff
and provision of medical supplies at the CCICs shall be done by the
Department of Health and Family Welfare. All other arrangements at the CCICs
other than medical manpower and supplies shall be made by the district
administration.

S/no. Designation Staff PPE Requirements

norms for 100 beds/day
for 100
beds
1. Specialist 2 4
2. Medical Officer 3 3

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 3 Ayurvedic Doctor 3 3
4. Nurse 15 15
S/no. Designation Staff PPE Requirements
norms for 100 beds/day
for 100
beds
5. Pharmacist 4 4
6. Lab Technician 4 4
7. Ward Attendant 15 15
8 Sweeper 15 15
9. Counselor 4 4
10. Data Entry 4 -
Operator
11 Security guard 15 15
12. Sanitary Supervisor 3 3

Total - 81 + (10% reserve )

 Details of PPE requirement for 20000 beds and

 HR availability on the portal of Department of Health are annexed
herewith as Annexure B.
 Manpower requirement for security and all security arrangements at
the CCICs shall be worked out by the Police Department.Internal
security arrangement shall be arranged through private agencies/PESCO
and outer ring of security shall be provided by Department of Police.

4. MOVEMENT PROTOCOL at CCICs

● Continuous sanitizing of hands at frequent intervals: The patients and

the medical staff should be instructed to sanitize their hands at regular
intervals.

● Patients to move in a specific line maintaining at least 3 ft. distance from

each other.

● Wearing of masks shall be mandatory for the patients and staffwithin the
facility especially during the interaction or moving outside the rooms.

● Display of protocols and IEC material at all prominent locations in the

facility

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 ● Decorum: The patients are expected to maintain decorum and cooperate
with the hospital staff with respect and are expected to patiently wait for
their turn.

● Separate entrances and exits for Patients and Staff, if possible to

reduce interaction
o If possible, the facility to have separate entrances and exits earmarked for
Patients and Staff to reduce interaction.
o In case of availability of multiple lifts, they should be marked for use by
staff, patients specifically. Lifts need to be sanitized frequently as per
protocol.Use of stairs to be recommended for people who do not have any
physical discomfort.
o If the center has multiple entry and exit gates available, gate numbers to
be allocated for the movement of patients and staff.

5. CHECKLISTS

To efficiently cater to various processes at the CCIC, a few of checklists have been
drawnup to provide guidance for setting up and operationalisation of CCIC. They
are as follows :

I. Facility Infrastructure
II. Waiting Area/Triage
III. Reception/Registration
IV. Medical Supplies for CCIC for 100 Beds
A. Medicines for Pharmacy
B. Medical requirement for 6 Bedded Emergency- Injections
C. Medical requirement for 6 Bedded Emergency-Medicines
D. Emergency Requirement for Staff and Instruments required
V. Laboratory Facility
VI. Throat Swab Collection (COVID Rapid Test)
VII. Isolation Room Facilities for Patients
VIII. Room Facilities for Doctors and Staff
IX. Infection Prevention and Control Practices
X. Environmental Cleaning

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 XI. Biomedical Waste Management
XII. Other Waste Management
XIII. Trainings conducted for Staff deployed

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 CHECKLIST I

FACILITY INFRASTRUCTURE
Checklist for Infrastructure Remarks

☐ Wards ☐ Rooms
1 Does the Facility have Ward or rooms?
☐ Both
2 Number ofwards available
Total number of beds available in the wards(distance
3 between two beds in a ward/room should be more
than one mentre)
4 Number of Rooms available
5 Total number of beds available in the rooms
Adequate hospital furniture,mattresses(one per room
6 ) and linen at the facility(4bed sheets per bed and ☐ Yes ☐ No
two pillow covers per bed )
7 Are washrooms available as 1 toilet per 8persons? ☐ Yes ☐ No

8 Provision for portable drinking water ☐ Yes ☐ No

9 Un-interrupted power supply on hotline ☐ Yes ☐ No

10 Availability of Generator for power back up ☐ Yes ☐ No

11 Availability of patient registration facility on HMIS ☐ Yes ☐ No

12 Availability of adequate computer and hardware ☐ Yes ☐ No

Availability of two dedicated mobile phone for doctor/
13 staff on duty with display of their numbers on each ☐ Yes ☐ No
floor
14 Internet connection with Wi-Fi ☐ Yes ☐ No
15 Availability of Medical examination room ☐ Yes ☐ No
16 Is there a triage protocol in place? ☐ Yes ☐ No
17 Availability of counseling room ☐ Yes ☐ No
18 Is there any dedicated sample collection Area ☐ Yes ☐ No
19 Dedicated lab for testing ☐ Yes ☐ No
20 Is there a separate room for doctors on duty? ☐ Yes ☐ No

21 Is there a separate room for nurses on duty? ☐ Yes ☐ No

22 Is there a separate room Para medics on duty? ☐ Yes ☐ No

23 Changing room with attached washroom ☐ Yes ☐ No

Whether PPEs available and located near the point
24 ☐ Yes ☐ No
of use?

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 Checklist for Infrastructure Remarks

Does the Available PPE Kit contains all of the

☐ Yes ☐ No
following
a. Gloves ☐ Yes ☐ No
b. shoe cover ☐ Yes ☐ No
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c. Face masks ☐ Yes ☐ No
d. 95 respirators ☐ Yes ☐ No
e.Eye protection (visor or goggles) ☐ Yes ☐ No
f. Face shield (provides eye, nose and mouth
☐ Yes ☐ No
protection)
Is there a pharmacy in the premises with storage and
26 ☐ Yes ☐ No
shelves?
27 Is there a separate room for pharmacist/s? ☐ Yes ☐ No
28 Is there a room for the Counsellor?
28 Availability of laundry services ☐ Yes ☐ No
29 Provision for cooked food ☐ Yes ☐ No
Cleanliness and sanitation facilities as per detailed
30 ☐ Yes ☐ No
list attached
31 Fire management plan ☐ Yes ☐ No
32 Security Plan ☐ Yes ☐ No
Whether the hospital limits the movement of patients
33 in the isolation facility outside for medically ☐ Yes ☐ No
necessary purposes only?
Stay arrangements within or near the premises for
34 clinical staff and doctors, if required with the ☐ Yes ☐ No
dedicated vehicle
Availability of ambulance for transport of patients
35 ☐ Yes ☐ No
(BLS and linkage with ALS)
Availability of non-touch water dispenser on each
36 floor ☐ Yes ☐ No
preferably with hot and cold water facility

37 Availability of Ramp or Lift ☐ Yes ☐ No

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 CHECKLIST II
WAITING AREA / TRIAGE

Remarks
Checklist for Waiting Area/ Triage
Is sufficient seating capacity available
maintaining 3ft.distance between chairs and
1 ☐ Yes ☐ No
rows?

Is cross ventilation available in the waiting

2 area? ☐ Yes ☐ No

Are Sanitizer dispensers available in waiting

area with an instruction poster near it for
3 ☐ Yes ☐ No
guidance?

Is Automatic Water dispenser along with paper

4 cup dispenser available in the waiting area? ☐ Yes ☐ No

`Are foot operated waste collection bins with

5 covered lids and related signage available in ☐ Yes ☐ No
waiting area ?
Are advisories and protocol displayed properly
6 in the waiting area? ☐ Yes ☐ No

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 CHECKLIST III
RECEPTION / REGISTRATION

Checklist for Reception Remarks

Whether alcohol-based hand sanitisers are

available in the reception area? ☐ Yes ☐ No
1
Whether one stretchersand at least
2wheelchairsare available at the entrance? ☐ Yes ☐ No
2
Whether there are physical barriers (e.g. glass
or plastic barriers), at reception areas to limit ☐ Yes ☐ No
3 close contact between staff and patients
Whether there are no touch waste containers
placed in the waiting area2? ☐ Yes ☐ No
4
Whether Public address/announcement system
☐ Yes ☐ No
5 is in place
Availability of HMIS for entering patient
information on computer ☐ Yes ☐ No
6
System for inventory management of essential
supplies is in place ☐ Yes ☐ No
7
Landline phone facility and internet connection
☐ Yes ☐ No
8
Whether Red Color-coded wrist tags available
for co-morbidity cases? ☐ Yes ☐ No
9
Whether signages/IEC material have been
displayed as per the protocols ☐ Yes ☐ No
10
Availability of furniture - OneTable, 3chairs
☐ Yes ☐ No
11
Availability of Computers and printer and wifi
☐ Yes ☐ No
12 connection
Availability of adequate stationary like
registers/A4 and Legal sheets/file covers/OPD ☐ Yes ☐ No
12 slips/glue/stapler/stapler pins/scissors
Whether the use of magazines and other
shared items has been discontinued from ☐ Yes ☐ No
13 supply to avoid infection?

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 CHECKLIST IV
MEDICAL SUPPLIES FOR CCIC FOR 100 BEDS

(A) MEDICINES FOR PHARMACY

Checklist of Medical Supplies

S.no. Description Quantity Availability Remarks

1 Tab. Paracetamol 5000 ☐ Yes ☐ No
2 Tab. Azithromycin 500 mg 3000 ☐ Yes ☐ No
3 Tab. Rabiprazole DSR 2000 ☐ Yes ☐ No
4 Tab. Livocetrizine 5000 ☐ Yes ☐ No
5 Tab. Derriphyline 5000 ☐ Yes ☐ No
6 Tab. Vit C 3000 ☐ Yes ☐ No
7 Tab. Vit. A+C+E 3000 ☐ Yes ☐ No
8 Tab. Osiltmivir 75 mg 2000 ☐ Yes ☐ No
9 Tab. Hydroxychloroquine 400 mg 600 ☐ Yes ☐ No
10 Tab. Hydroxychloroquine 200 mg 1200 ☐ Yes ☐ No
11 Tab. Lapinavir or Retonavir 1000 ☐ Yes ☐ No
12 Tab. N-Acetyl Cysteine 600 mg 3000 ☐ Yes ☐ No
13 Tab. Montair 3000 ☐ Yes ☐ No
14 Cap. Amoxyclave 625 mg 3500 ☐ Yes ☐ No
15 Syp. Paracetamol 300 ☐ Yes ☐ No
16 Syp. Azithromycin 200 ☐ Yes ☐ No
17 Syp. Livocetrizine 200 ☐ Yes ☐ No
18 Syp. Amoxyclave 300 ☐ Yes ☐ No
19 Cough Syp. 300 ☐ Yes ☐ No
20 Syp. Expectorant 200 ☐ Yes ☐ No
21 Inj. Ranitidine 300 ☐ Yes ☐ No
22 Inj. Derriphyline 500 ☐ Yes ☐ No
23 Inj. Paracetamol 500 ☐ Yes ☐ No
24 Inj. Amoxyclave 1.2 gm 2000 ☐ Yes ☐ No
25 Inj. Hydrocortisone 500 ☐ Yes ☐ No
26 Inj. Dexamethasone 300 ☐ Yes ☐ No
27 RL 1000 ☐ Yes ☐ No
28 DNS 1000 ☐ Yes ☐ No
29 NS 500 ml 1000 ☐ Yes ☐ No
30 D 5% 1000 ☐ Yes ☐ No
31 I/V set 500 ☐ Yes ☐ No

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S.no. Description Quantity Availability Remarks
32 BT set 10 ☐ Yes ☐ No
33 Leucoplast Fixer 200 roll ☐ Yes ☐ No
34 Vein Flow 18,20,22,24 Nos. 200 each ☐ Yes ☐ No

10 cm Three way Cannula with pipe

35 200 each ☐ Yes ☐ No
18,20,22 Nos.
36 S/Gloves 6.5, 7, 7.5 Nos 3000 each ☐ Yes ☐ No
37 Examination Gloves 6.5,7,7.5 No. 3000 each ☐ Yes ☐ No

38 Sodium Hypochlorite Sol 10% 20 can ☐ Yes ☐ No

39 Hand Sanitiser Alcohol Based 300 pcs ☐ Yes ☐ No

40 Three Layer Mask 2000 ☐ Yes ☐ No

(B)MEDICAL REQUIREMENT FOR 6 BEDDED EMERGENCY FACILITY- INJECTIONS

Checklist of Medical Supplies ( 6 bedded Emergency)

S.no. Description Quantity Availability Remarks

1 Inj.Trenexa 10 ☐ Yes ☐ No
2 Inj. Epsolin 10 ☐ Yes ☐ No
3 Inj.Dopamine 10 ☐ Yes ☐ No
4 Inj. Hydrocortisone 10 ☐ Yes ☐ No
5 Inj. Sodium Chloride 10 ☐ Yes ☐ No
6 Inj. Potassium 10 ☐ Yes ☐ No
7 Inj. Atropine 10 ☐ Yes ☐ No
8 Inj. Adrenaline 10 ☐ Yes ☐ No
9 Inj. Noradrenaline 10 ☐ Yes ☐ No
10 Inj. Calcium Gluconate’ 10 ☐ Yes ☐ No
11 Inj. Diazepam 10 ☐ Yes ☐ No
12 Inj. Midazolam 10 ☐ Yes ☐ No
13 Inj.Deriphyllin 10 ☐ Yes ☐ No
14 Inj.Dexamethasone 10 ☐ Yes ☐ No
15 Inj. Lasix 10 ☐ Yes ☐ No
16 Inj. Dextrose 25% 10 ☐ Yes ☐ No

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S.no. Description Quantity Availability Remarks
17 Inj. Sodabicarb 10 ☐ Yes ☐ No
18 Inj. Diclofenac 10 ☐ Yes ☐ No
19 Inj. Drotaverine 10 ☐ Yes ☐ No
20 Inj. Hyoscine 10 ☐ Yes ☐ No
21 Inj. Tremadol 10 ☐ Yes ☐ No
22 Inj. Fortwin 10 ☐ Yes ☐ No
23 Inj. Phenargan 10 ☐ Yes ☐ No
24 Inj. Rantac 10 ☐ Yes ☐ No
25 Inj. Emset 10 ☐ Yes ☐ No
26 Inj. Avil 10 ☐ Yes ☐ No
27 Infusion 5% Dextrose 10 ☐ Yes ☐ No
28 Infusion DNS 10 ☐ Yes ☐ No
29 Infusion Ringer Lactate 10 ☐ Yes ☐ No

30 Infusion Normal Saline 100 ml 10 ☐ Yes ☐ No

31 Infusion Mannitol 10 ☐ Yes ☐ No

32 Infusion Isolyte P 10 ☐ Yes ☐ No
33 Infusion PCM 10 ☐ Yes ☐ No
34 Inj. Dextrose 25% 10

35 Disposable Syringes 2cc, 5cc 10 ☐ Yes ☐ No

36 Gauze pieces 10 ☐ Yes ☐ No

37 Cotton balls 10 ☐ Yes ☐ No
38 Spirit 10 ☐ Yes ☐ No
39 I/V sets 10 ☐ Yes ☐ No
40 Angiocaths 20,21,22 10 ☐ Yes ☐ No
41 Cannula fixator 10 ☐ Yes ☐ No
42 Micropore 10 ☐ Yes ☐ No

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(C) MEDICAL REQUIREMENT FOR 6 BEDDED EMERGENCY FACILITY- MEDICINES

Checklist of Medical Supplies (Oral, for 6 beded Emergency)

S.no. Description Quantity Availability Remarks

1 Tab. Sorbitrate S/L 100 ☐ Yes ☐ No
2 Tab.PCM 100 ☐ Yes ☐ No
3 Tab.Cetrizine 100 ☐ Yes ☐ No
4 Cap.Amoxycillin 100 ☐ Yes ☐ No
5 Tab.Erythromycin 100 ☐ Yes ☐ No
6 Tab.Azithromycin 100 ☐ Yes ☐ No
7 Tab.Asthalin 100 ☐ Yes ☐ No
8 Tab. Deriphyllin 100 ☐ Yes ☐ No
9 Asthalin Inhalers 100 ☐ Yes ☐ No
10 Budecort Inhalers 100 ☐ Yes ☐ No
11 Betadine Lotion 100 ☐ Yes ☐ No
12 Tab.Hydroxychloroquine 100 ☐ Yes ☐ No
13 Tab. Domstal 100 ☐ Yes ☐ No
14 Tab.Omeprazole 100 ☐ Yes ☐ No
15 Tab.Rantac 100 ☐ Yes ☐ No
16 Tab.Ofloz OZ 100 ☐ Yes ☐ No
17 Tab. Nimulid 100 ☐ Yes ☐ No
18 Tab. Clonazepam 0.5mg 100 ☐ Yes ☐ No
19 Tab. Amlodipine 5mg 100 ☐ Yes ☐ No
20 Tab. Atenolo 50mg 100 ☐ Yes ☐ No
21 Tab. Vitamin C 100 ☐ Yes ☐ No
22 Tab. Sorbitrate S/L 100 ☐ Yes ☐ No
23 Tab. Asprin 100 ☐ Yes ☐ No
24 Soframycin Ointment 100 ☐ Yes ☐ No
25 Bandages 100 ☐ Yes ☐ No
Carboxymethylcellulose Eye
26 100 ☐ Yes ☐ No
Drops
27 ORS 100 ☐ Yes ☐ No
28 MVI 100 ☐ Yes ☐ No
29 Tab.Zinc 100 ☐ Yes ☐ No
30 Cough Suppresants 100 ☐ Yes ☐ No

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(D) EMERGENCY REQUIREMENT FOR STAFF (Per 100 BEDS)

Emergency requirement for staff (PER 100 BEDS)

1 PPE Kits 100 ☐ Yes ☐ No

2 N95 Mask 100 ☐ Yes ☐ No
3 Triple Layered Mask 1000 ☐ Yes ☐ No
4 Disposable gloves 100 ☐ Yes ☐ No
5 Surgical Caps 50 ☐ Yes ☐ No
6 Sanitizers 200 ☐ Yes ☐ No
7 Liquid Soaps 200 ☐ Yes ☐ No
8 Scrub Suits 200 ☐ Yes ☐ No
9 Eye Shields 100 ☐ Yes ☐ No
Instruments required

1 Infrared thermometer with cells 2 ☐ Yes ☐ No

2 BP Apparatus 2 ☐ Yes ☐ No
3 Pulse Oxymeter with cells 4 ☐ Yes ☐ No

4 Oxygen cylinder with flowmeter 6 ☐ Yes ☐ No

Suction apparatus with suction
5 2 ☐ Yes ☐ No
tips
6 Nebulizers 10 ☐ Yes ☐ No
Nebulizer masks adult and
7 10 each ☐ Yes ☐ No
pediatrics
8 Sthethoscope 6 ☐ Yes ☐ No
9 ECG Machine 1 ☐ Yes ☐ No
10 Glucometer with strips 2 ☐ Yes ☐ No
11 Crash cart 1 ☐ Yes ☐ No
1 per floor and
12 Medicine trolleys ☐ Yes ☐ No
1 emergency
1 in emergency
13 Biomedical waste bins and one per ☐ Yes ☐ No
floor
Sufficient
14 Biomedical waste collection bags quantity for daily ☐ Yes ☐ No
use

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 CHECKLIST V
LABORATORY FACILITY

Checklist for Labs

Quantity/
S.no. Description Availability Remarks
Type
1 Disposable syringes and needles 500 ☐ Yes ☐ No
500g packs
2 Cotton ☐ Yes ☐ No
(6)
3 Spirit 5L ☐ Yes ☐ No
4 Tourniquets 10 ☐ Yes ☐ No
Sample collection Vials ( Red,
5 Purple, Black, Biochemistry, CBC, 100 each ☐ Yes ☐ No
PTI)
6 Needle cutters 1 ☐ Yes ☐ No
BMW Buckets ( Red, yellow,
7 Green ) with envelops as per 1 each ☐ Yes ☐ No
protocol of BMW management
Urine Sample Collection
9 100 ☐ Yes ☐ No
Containers
10 Water source and sink 1 ☐ Yes ☐ No
11 Gloves 50 ☐ Yes ☐ No
12 Mask N95 25 ☐ Yes ☐ No
13 Hand Sanitizers 5 ☐ Yes ☐ No
14 Liquid Soaps 5 ☐ Yes ☐ No
A) Kits for tests ( ERBA Kits – one kit minimum 50 tests)
LFT
1 SG0T Blood Sugar ☐ Yes ☐ No
2 SGPT CPK (MB) ☐ Yes ☐ No
3 Alkaline Phosphatase Lipid Profile ☐ Yes ☐ No
4 Total Bilirubin Cholesterol ☐ Yes ☐ No
5 Direct Bilirubin Triglyceride ☐ Yes ☐ No
6 Serum Amylase HDL ☐ Yes ☐ No
RFT
7 B.urea LDL ☐ Yes ☐ No
Electrolyte
8 Serum Creatanine ☐ Yes ☐ No
Rack
9 Serum Uric Acid ☐ Yes ☐ No

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 Serum Total
10 Serum Calcium ☐ Yes ☐ No
Proteins
11 Serum Albumin ☐ Yes ☐ No
12 Standards for each Test ☐ Yes ☐ No
B) Reagents
13 Albumin ☐ Yes ☐ No
14 Suger ☐ Yes ☐ No
15 Ketone body strips ☐ Yes ☐ No
Main Lab Equipment and Requirements

1 Water Source and Sink ☐ Yes ☐ No

2 R.O water for DW ☐ Yes ☐ No
3 Centrifuge Machine ☐ Yes ☐ No
4 CBC Machine (3 Parts / 5 Parts) ☐ Yes ☐ No
5 Semi Auto analyser (2) ☐ Yes ☐ No
6 Incubator/ Water Bath ☐ Yes ☐ No
7 Electrolyte Machine ☐ Yes ☐ No
8 Refrigerator ☐ Yes ☐ No
9 Micropipettes (5-50 ML) 4 each ☐ Yes ☐ No
Micropipettes (100-1000 ML ) 4
10 ☐ Yes ☐ No
each
Tips – Yellow (Small) , White
11 ☐ Yes ☐ No
(Large)
Store Requirements
1 Refrigerator 300 L 1 ☐ Yes ☐ No
2 Sodium Hypochlorite 10L ☐ Yes ☐ No
3 Spirit 5L ☐ Yes ☐ No
4 Hand Sanitizers 10 bottles ☐ Yes ☐ No
5 Liquid Soaps 10 bottles ☐ Yes ☐ No
6 Gloves 100 pairs ☐ Yes ☐ No
7 Body Bags 5 ☐ Yes ☐ No
8 N95 Masks 50 ☐ Yes ☐ No
Pathology
1 CBC analyser (3 bottles) 700 tests ☐ Yes ☐ No
2 Cell Pack 500 tests ☐ Yes ☐ No
3 Cell clear 1 month ☐ Yes ☐ No

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 CHECKLIST VI
THROAT SWAB COLLECTION (COVID-19, RAPID TEST)

Checklist for throat swab collection

1 Centrifuge Machine 1 ☐ Yes ☐ No

2 Red Cap tubes 100 ☐ Yes ☐ No
3 Micropipettes ( 5-50ML) 4 ☐ Yes ☐ No
4 Rapid Card test 100 ☐ Yes ☐ No
5 BTM Bottles (With Swabs) 100 ☐ Yes ☐ No
6 Parafilms to wrap bottles 200 ☐ Yes ☐ No
7 Thermal boxes 200 ☐ Yes ☐ No
8 Ziplock Bags 200 ☐ Yes ☐ No
9 Ice packs 50 ☐ Yes ☐ No
10 Refrigerator 1 ☐ Yes ☐ No
Yellow and Red Waste Bins,
11 Green Waste bins, envelopes 2 ☐ Yes ☐ No
yellow and red
12 Sodium Hypochlorite 1% 10 L 5 Cans ☐ Yes ☐ No
13 Markers 4 ☐ Yes ☐ No
14 PPE Kits 4 ☐ Yes ☐ No
15 Gloves 50 ☐ Yes ☐ No
16 Mask N95 25 ☐ Yes ☐ No
17 Hand Sanitizers 5 ☐ Yes ☐ No
18 Liquid Soaps 5 ☐ Yes ☐ No

21
 CHECKLIST VII
ISOLATION ROOM FACILITY FOR A PATIENT

Patient Room Requirement Checklist Remarks

1 Availability of Bed-1
☐ Yes ☐ No
2 AvailabilityofMattress-1
☐ Yes ☐ No
3 Availability of Attached Toilet/Washroom
☐ Yes ☐ No
4 Availability of Tube light/bulb (at least 1)
☐ Yes ☐ No
5 Availability of Fan
☐ Yes ☐ No
6 Availability of AC (Note: Centralized is
☐ Yes ☐ No
strictly prohibited)
7 Availability of Exhaust fan
☐ Yes ☐ No
9 Availability of 4 Bed sheets and 2 Pillow
☐ Yes ☐ No
covers, 1 Blanket
10 Availability of Bedside locker
☐ Yes ☐ No
11 Availability of 2 Towels (1big and 1 small )
☐ Yes ☐ No
12 Availability of 1Tray, Jug/Water bottle and
one glass ☐ Yes ☐ No

13 Availability of 1 Plate/ Spoon/tea mug

☐ Yes ☐ No
15 Availability of Sanitizer
☐ Yes ☐ No
16 Availability of Dustbin andlaundry bag
☐ Yes ☐ No
17 Availability of Plug point for mobile charging
☐ Yes ☐ No
18 Availability of 1 chair
☐ Yes ☐ No
19 Availability of Television
☐ Yes ☐ No
20 Availability of Almirah/cupboard - 1
☐ Yes ☐ No
21 Availability of shelves ☐ Yes ☐ No
22 Availability of soap bars for bathing/ washing
☐ Yes ☐ No
clothes
22
 Toilet/ Washroom Facility Checklist

23 Water supply
☐ Yes ☐ No
24 Geyser
☐ Yes ☐ No
25 Soap dispenser
☐ Yes ☐ No
26
Functional flush ☐ Yes ☐ No
27 Bucket and mug – 1 ☐ Yes ☐ No
28
Exhaust fan ☐ Yes ☐ No
29
Light Bulb ☐ Yes ☐ No

Laundry

30 Protocol for cleaning( Detailed protocol is

attached with the document as ☐ Yes ☐ No
Annexure C)
31 Staff deployment for laundry to run it in shifts
☐ Yes ☐ No
32 Separate cleaning provision for staff and
patient laundry(gowns, pillow covers, sheets) ☐ Yes ☐ No

33 Laundry bag
☐ Yes ☐ No
34 Disinfecting used laundry with hypochlorite
solution ☐ Yes ☐ No

35 Trolley for carrying dirty and washed laundry

☐ Yes ☐ No
36 Washing machine plus dryer(Laundry unit)
☐ Yes ☐ No
37 Ironing facility/ calendaring machine
☐ Yes ☐ No

23
 CHECKLIST VIII
ROOM FACILITY FOR DOCTORS AND STAFF

Requirements for doctor duty room and medical officer room

1 Bed 1 each ☐ Yes ☐ No

2 Mattress 1 each ☐ Yes ☐ No
3 Bedside Table 1 each ☐ Yes ☐ No
4 Chair 1 each ☐ Yes ☐ No
5 Table 1 each ☐ Yes ☐ No
6 LCD with working cable
1 each ☐ Yes ☐ No
connection
7 Refrigerator 1 each ☐ Yes ☐ No
8 Bedsheets 2 each ☐ Yes ☐ No
9 Pillows 1 each ☐ Yes ☐ No
10 Pillow covers 2 each ☐ Yes ☐ No
11 Closed Dustbin 1 each ☐ Yes ☐ No
Requirements for staff duty room

12 Bed 1 each ☐ Yes ☐ No

13 Mattress 1 each ☐ Yes ☐ No
14 Bedside Table 1 each ☐ Yes ☐ No
15 Chair 1 each ☐ Yes ☐ No
16 Table 1 each ☐ Yes ☐ No
17 Bedsheets 2 each ☐ Yes ☐ No
18 Pillows 1 each ☐ Yes ☐ No
18 Pillow covers 2 each ☐ Yes ☐ No
20 Closed Dustbin 1 each ☐ Yes ☐ No

24
 CHECKLIST IX
INFECTION PREVENTION AND CONTROL PRACTICES

Checklist for Infection Prevention and Control Remarks

Does the CCIC have Infection control

Committee?(The committee shall comprise
of facility-in-charge, Specialist,Doctor, senior ☐ Yes ☐ No
staff nurse,Lab Technician,pharmacist,Class
1 4 supervisor)
Are there any infection control
☐ Yes ☐ No
protocols/guidelines available?
2
Functioning hand washing station at the
3 entrance ☐ Yes ☐ No
Is alcohol-based hand sanitizer available at
☐ Yes ☐ No
4 all locations?
Are there posters to reinforce hand washing
and PPE usage available at hand washing
☐ Yes ☐ No
stations and at all relevant locations ?
5
Is there a facility to sanitize the CCIC twice ☐ Yes ☐ No
daily with sodium hypochlorite?
6

CHECKLIST X
ENVIRONMENTAL CLEANING

Checklist for Environmental Cleaning Remarks

☐ Yes ☐ No
1 Is there cleaning chart?
Is spray of hypochlorite solution being done
☐ Yes ☐ No
2 thrice a day?
Are surfaces at the facility (doctors
room,counselors room, waiting area, ☐ Yes ☐ No
3 reception, lab cleaned after every 2 hours?
Are common washroom cleaned after every
two hours?( The detailed protocol is
attached with the document as Annexure
4 D) ☐ Yes ☐ No

25
 CHECKLIST XI
BIOMEDICAL WASTE MANAGEMENT (BMWM)

Checklist for Biomedical Waste Management (BMWM) Remarks

Availability of SOP for BMW

☐Available ☐
management?Detailed guidelines available
as Annexure E Not Available
1
☐ Available ☐
2 Availability of agreement with CWTF Not Available
Are color codes (red and yellow) bins
☐ Yes ☐ No
3 available in BMW management?
Are white and blue containers available for
4 BMW Management
☐CWTF ☐
Deep burial ☐
5 Method of disposing of biomedical wastes? Incineration
Disposal of sharps as per the standard
☐ Yes ☐ No
6 protocol?
7 Availability of biomedical waste trolley? ☐ Yes ☐ No
Whether the COVID BMW waste is labelled
☐ Yes ☐ No
8 separately?
9 Availability of dedicated BMW collection area? ☐ Yes ☐ No
BMW collected from isolation facility within
☐ Yes ☐ No
10 48hrs?

CHECKLIST XII
OTHER WASTE

Checklist for Other Waste Management Remarks

Availability of linkage for disposingoffnon- ☐Available ☐

1 medical waste (e.g. Kitchen waste) Not Available
Are color coded (Green and Blue) bins
☐ Yes ☐ No
2 available for dry and wet waste?

26
 CHECKLIST XIII
TRAININGS CONDUCTED FOR STAFF DEPLOYED

Checklist for Training Remarks

1 Trainings for medical staff ☐ Yes ☐ No

2 Training of paramedics and ward attendants
2 Training for Sanitation staff ☐ Yes ☐ No
3 Training for Security staff ☐ Yes ☐ No
Training for Data entry operators on file
4 ☐ Yes ☐ No
preparation and HIMS
Training for Laundry staff (infection control) on
5 ☐ Yes ☐ No
washing and handling of infected linen
Training on Bio Medical Waste Management in
6 ☐ Yes ☐ No
the facility
Training for support staff done(catering staff,
7 electrician,sewer men who would be visiting ☐ Yes ☐ No
facilityetc)

ANNEXURES

ANNEXURE A Covid-19 :GoI Guidelines on Dead Body Management

ANNEXURE B PPE Requirement for 20,000 Beds in the State and Availibility of
Medical Staff on the Portal of Department of Health

ANNEXURE C Protocol for Handling Laundry and equipment and material

requirement for laundries at CCICs

ANNEXURE D - Protocol for Cleaning of Washroom/Other Spaces at the CCIC

- List of equipment and consumables required for cleaning
ANNEXURE E Protocol for Bio Medical Waste Management

27