Synopsis

POST PANDEMIC IMPACT ON PLANNING OF HOSPITALS IN INDIA

RUCHITA DASGUPTA I SPA/NS/BEM/781

Categorized as a critical infrastructure, healthcare facilities are responsible for ensuring health and safety
of the citizens within a country. Holistically, these facilities are planned for prevention, diagnosis, therapy,
nursing and administering other medically relevant physical and psychological needs of a community.
(CPWD, 2019) India develops public healthcare infrastructure as a three-tier system depending upon the
population served – Primary level HRH, Secondary level HRH and Tertiary level HRH. Tertiary HRH are
district level hospitals serving more than 5,00,000 population and offer specialized services for patients
with different disease profile through outpatient department, inpatient department, surgical department,
imaging and laboratory and ancillary services such as laundry, dietary unit, etc.

Due to the high load of incoming patients in various departments, healthcare facilities provide an ideal
atmosphere for spread of communicable diseases. One of the major risks lying in this domain is the spread
of Healthcare Associated Infections (HAI). Healthcare Associated Infections

NABH (2015) has elaborately defined standards for prevention and reduction of risk related to HAI in
patients and employees, with action plans to control outbreak of infection, disinfection activities, bio
medical waste management, staff training programme and securing employee health. Guideline on Airborne
Infection Control (2010) and National Guidelines for Infection Prevention and Control in Healthcare
Facilities (2020) lay down a descriptive set of requirements necessary for the planning and design of
hospitals and other settings. On a global platform, WHO (2018) and CDC (2019) have provided
recommendations for infection control for healthcare facilities.

The health status measured in National Health Profile (2019) reported that about 69% of communicable
diseases are accounted for by acute respiratory infection resulting in about 27% of mortality. Under the
National Health Mission, MoHFW has laid out several programme for communicable disease control.
Additionally, initiatives started by ICMR and NCDC, including accreditation and certification programmes
implemented by NABH provide a way forward for infection surveillance and prevention (Swaminathan, et
al., 2017).

Lack of adequate systems and infrastructure for infection prevention and control in many healthcare
facilities contributes to the development of healthcare associated infections and the spread of resistant
pathogens (Swaminathan, et al., 2017). 53% of hospitals in the country are not prepared for surge capacity
for patients with infectious diseases (Gupta, et al., 2018). Moreover, the recent outbreak of SARS Covid-
19 has put forward several serious question on the efficiency of infection control measures for planning and
operation of healthcare facilities in the country.

1.1. Post pandemic guidelines in healthcare facilities

HAI are associated with increased morbidity (longer hospitalization), mortality and cost of healthcare
(Gupta, et al., 2018). Several national and international organizations such WHO, CDC, MoHFW, AIIMS,
etc. have defined guidelines for prevention of infectious diseases and improvement of safety of healthcare
facilities after Covid outbreak.

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1.1.1. Guidelines for Setting up Isolation Facility / Ward

NCDC provides a guidance document for preparation of isolation facility for district level hospital and
secondary healthcare facilities. Most of the existing hospitals in the country have used this document for
management of Covid-19 patients.

1.1.2. Interim infection and prevention control recommendations during Covid-19 Pandemic
The CDC had defined recommendations for infection control for healthcare facilities in 2003, which was
updated according to outbreaks of diseases in 2014, 2018 and 2019 respectively. The most recent updating
during Covid-19 Pandemic included detailed recommendations for various facility types such as outpatient
department, ambulatory care, radiology, etc.

1.1.3. Infection and prevention control guidance for long-term care facilities in the context of
COVID-19
Similar to CDC, WHO has deployed interim report for management of healthcare facilities. This guidance
document includes recommendations related to management of staff and visitor, laundry, bio-medical
waste, HVAC services, etc.

1.1.4. Infection Prevention and Control Guideline for 2019-nCov

The Hospital Infection Control Committee of AIIMS at New Delhi defines a set of guidelines for
management of hospital facilities and safety of health worker. Though the guidelines are demarcated on the
basis of departments, spatial requirements are missing.

1.1.5. District Action Plan

Wayanad District Administration of Kerala has published District Action Plan for construction of COVID
hospital. This includes preparedness of hospitals through COVID cell, infrastructure arrangements with
route maps, planning and management of patient care, human resource management and hospital infection
control management.

1.2. Gap Identification

Though several documents have been published highlighting the requirements for planning, design and
management of healthcare facilities, a consolidated implementation document for planning and design of
various departments is yet to be formulated for India. A successful health sector transformation in the
country will require simultaneous reduction in funding and provision of fragmentation (NITIAayog, 2019).
The cost implication for provision of the facilities in order to curb the spread of HAI need to be developed
for realistic project implementation.

1.3. Aim
To develop a framework for improving the resilience of tertiary hospitals to Healthcare Associated
Infections (HAI) and derive associated project cost.

1.4. Objectives
1. To study various risk assessment tools and identify risks associated with HAI in the general facilities
of tertiary hospitals.
2. To compare the past and present standards and guidelines related to HAI and derive mitigation
measures.

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3. To develop an assessment framework for evaluating resilience of general facilities in tertiary hospitals
to HAI and propose mitigation measures.
4. To implement the derived framework on case studies and generate cost options.

1.5. Methodology
SN Objective Tool Keywords Outcome
1 To study various risk Literature  Risks of HAI on multi- Establish tangible
assessment tools and review, specialty hospitals and its and intangible risks
identify risks Questionnaire various departments. of HAI on various
associated with HAI in survey  Challenges faced in departments of
the general facilities of healthcare facilities during multi-specialty
tertiary hospitals. Covid-19 outbreak. hospitals.
 Risk assessment tools
2 To compare the past Standards and  Functional analysis of multi- Generate department
and present standards Guidelines, specialty hospitals. wise mitigation
and guidelines related Secondary  Guidelines and government guidelines for
to HAI and derive case study documents. resilience to HAI.
mitigation measures.  Case examples

3 To develop an  Infection control risk Framework for

assessment framework assessment deciding new
for evaluating  Case examples of mitigating construction or
resilience of general and preparedness measures of upgradation.
facilities in tertiary Covid-19 outbreak
hospitals to HAI and
propose mitigation
measures.
4 To implement the Case Study  Define project scope Conclusion
derived framework on  Derive cost options
case studies and
generate cost options.

References

CBHI, 2019. National Health Profile 2019 – 14th Issue, New Delhi: Central Bureau of Health Intelligence,
Ministry of Health and Family Welfare, Government of India.

CDC, 2019. Guidelines for Environmental Infection Control in Health-Care Facilities, Atlanta: Centers for
Disease Control and Prevention.

Gupta, S. et al., 2018. National survey of infection control programmes in South Asian association for
Regional Cooperation countries in the era of patient safety. Indian Journal of Medical Microbiology, 36(4),
pp. 577-581.

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HICC, 2020. Infection Prevention &Control Guidelines for 2019-nCoV (COVID-19), New Delhi: AIIMS.

MoHFW, 2010. Guidelines on Airborne Infection Control in Healthcare and Other Settings, New Delhi:
Ministry of Health and Family Welfare.

MoHFW, 2020. National Guidelines for Infection Prevention and Control in Healthcare Facilities, s.l.:
Ministry of Health and Family Welfare.

NABH, 2015. Guide Book to Accreditation Standards for Hospitals. 4th Edition ed. s.l.:National
Accreditation Board for Hospitals and Healthcare Providers .

NCDC, 2020. Covid-19 Outbreak: Guidelines for Setting up Isolation Facility/Ward, New Delhi: National
Centre for Disease Control.

NITIAayog, 2019. Health System for a New India: Building Blocks – Potential Pathways to Reform, New
Delhi: Pradhan Mantri Jan Arogya Yojna, Government of India.

Swaminathan, S. et al., 2017. Strengthening infection prevention and control and systematic surveillance
of healthcare associated infections in India. TheBMJ, Volume 358:j3768, pp. 59-61.

Wayanad District Administration, 2020. District Action Plan, s.l.: Wayanad District Administration.

WHO, 2018. Improving Infection Prevention and Control at the Health Facility, Switzerland: World Health
Organization.

WHO, 2021. Interim Guidance: Infection prevention and control guidance for long-term care facilities in
the context of COVID-19, s.l.: World Health Organization.