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IPC SCORECARD for rapid assessment of health facilities (COVID-19)

0.0 0. Health Facility and Assessment Information

0.01 Date of assessment

0.02 Health Facility Name Evuxakeni Hospital

0.03 Health Zone Mopani District
0.04 Health Area Greater Giyani
0.05 Number of Beds 400
0.06 Number of Health Personnel

0.07 Type of Health Facility Mixed facilities (Covid-19 patients and

non-Covid-19 patients)

0.08 Level of care

2
0.091 Assessor's Name Shimange M E
0.092 Assessor's Email [email protected]
0.093 Assessor's Phone 0849920646/0836516168

ID ASSESSMENT/THEMATIC CRITERIA Response SCORE PROPOSED ACTIONS

1.0 1. IPC program at the facility 3
1.1 The facility has an identified person, or an IPC focal point, or a Hygiene/IPC Committee who are Yes 1
responsible, accountable, have established ToRs, known authority, and dedicated time to
implement IPC tasks

1.2 The facility has IPC guidelines according to the service delivery system at that facility Yes 1

1.3 The facility produces a weekly report of implemented IPC activities Yes 1

2.0 2. Triage available 3

2.1 Temperature and symptoms of Covid-19 are correctly verified - Functional ThermoFlash Yes 1

2.2 Triage forms, registers, and educational materials (signs, symptom posters) are available and Yes 1
properly utilized and displayed
2.3 For each open entry point into the healthcare facility, a triage station is established and Yes 1
operational
3.0 3. Identification of an isolation/waiting area 3
3.1 The "isolation" area is easily identified, well ventilated , and separate from other units/services Yes 1 No isolation erea only side ward that are utilized

3.2 Dedicated latrines/toilets (or individual bedpans/urinals) are available Yes 1

3.3 The isolation area contains: handwashing facilities, equipment (PPE, bedpan/urinary, etc.), an area Yes 1
for putting on PPE and another for taking off PPE (well respected circuit)

4.0 4. Hand washing/Hand washing facilities 3

4.1 Every entrance into the facility, every toilet, and every individual care area contains: hand washing Yes 1
station with clean water + soap and/or Hydro-alcoholic solution and/or 0.05% chlorinated water
solution [when the first two are not available]

4.2 Staff are able to perform hand hygiene according to WHO guidelines Yes 1
4.3 Posters on proper hand hygiene technique are present at each hand hygiene station Yes 1

5.0 5. Availability and use of Personal Protective Equipment (PPE) 3

5.1 All PPE are accessible to staff at all times and in sufficient quantitiy (gloves, masks, aprons/gowns, Yes 1
eye protection)
5.2 Posters (standard precautions and Covid-19) on how to put on and take off PPE are visibly Yes 1
displayed
5.3 Staff are able to put on and take off PPE according to the WHO guidelines Yes 1

6.0 6. Waste segregation 3

6.1 Sealed, covered and labelled (infectious or non-infectious) waste bins and waste management Yes 1
forms are available at all patient service points),
6.2 Sharps containers are available at all points of use Yes 1

6.3 Waste is sorted according to the type of waste (e.g. indicated by colours or labeling): Infectious, Yes 1
non-infectious, sharp (from source, during collection, to disposal and/or treatment)

7.0 7. Waste disposal 2

7.1 Staff wear appropriate PPE (gloves, masks, apons/gowns, eye protection) when handling, Yes 1
seperating, and/or transporting waste

7.2 Waste is burned on site in an incinerator or other treatment system (autoclave), or there is a Yes 1
system for transporting it safely to another suitable location

7.3 A placenta or organic waste pit is present and used when required No 0 No maternity ward in the facility
8.0 8. Staff training 3
8.1 All staff have been trained on at least standard precautions, additional precautions (practical and Yes 1
theoretical periods) and a focus on COVID -19 within the last 6 months
8.2 A register is kept containing the names of the health workers who were trained, the training date, Yes 1
the training type, and the organization that provided the training
8.3 The health worker receives continuing training through on-site supervision Yes 1
9.0 9. Intra-hospital suspicious case alert (at health facility level) 2
9.1 A hotline is established and well promoted Yes 1 Through occupational health nurse
9.2 Inpatients are screened at least twice a day to identify suspect cases No 0 Only once a day

9.3 Once identified, suspect cases are moved to the isolation/transit area and an alert is triggered Yes 1

10.0 10. Sterilization 3

10.1 Sterilized equipment is available (such as autoclave, poupinel and accessories needed for Yes 1
sterilization, PPE)
10.2 SOPs are available on how to perform sterilization of materials/equipment Yes 1

10.3 All health staff performing any sterilization process has been trained Yes 1

11.0 11. Bio-cleaning of the patient's environment 3

11.1 SOP are available on how to perform cleaning/disinfection (including cleaning schedule and Yes 1
monitoring)
11.2 Full time health staff performing cleaning and disinfection have been trained (cleaning, Yes 1
disinfecting, HCF waste management)
11.3 Cleaners wear appropriate PPE (gloves, masks, aprons/gowns, eye protection) Yes 1

12.0 12. Health worker exposure or infection with Sars-Cov2 3

12.1 An assessment and management protocol is in place (including a register, assessment tools, Yes 1
communication, etc.) for exposed or confirmed health workers
12.2 The management of exposed and confirmed health personnel is clearly defined and ensured Yes 1

12.3 When a health worker is exposed (or confirmed), an established team is in place, alerted, and Yes 1
begins to perform an investigation
13.0 13. Water Supply and storage in the health facility 3
13.1 A functional water supply within the health facility compound/premise, including purified water Yes 1
point safe for drinking, and water for other usages -handwashing, cleaning, toilets, is available and
operational

13.2 A stand-by storage tank installed in the health facility to cover water needs for at least 48 hours Yes 1
during main water shortages is available
13.3 A functional wastewater treatment system onsite (for example, septic tank Yes 1
with outlet to a drainage pit) or wastewater is collected, treated and disposed offsite

14.0 14. Sanitation and Hygiene in the health facility 3

14.1 At least one functional and clean toilet within the health facility is available Yes 1

14.2 Dedicated toilets/latrines for each gender are visible identifiable and available Yes 1
14.3 At least one separate and dedicated toilet for healthcare workers is available? (ideally two, sex- Yes 1
segregated)

95% GRAND TOTAL 40 / 42

FOLLOW-UP RECOMMENDATION BASED ON FACILITY PERFORMANCE
Once a week

Interpretation Classifications
Once a day Score < 50%
Twice or thrice a week 50% < Score < 75%
Once a week Score > 75%
Health Facility Name Evuxakeni Hospital
Date 22/Feb/2022

IPC SCOR ECA R D for r apid ass es s m ent of health faciliti es

(COVID-19)
0 1 2 3

1. IPC program at the facility

3. Identification of an isolation/waiting area

5. Availability and use of Personal Protective Equipment

(PPE)

7. Waste disposal

9. Intra-hospital suspicious case alert (at health facility

level)

11. Bio-cleaning of the patient's environment

13. Water Supply and storage in the health facility

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0.091
0.092
0.093

ID COMMENTS Gaps Action to be taken Who When

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Interpretation Classifications

Twice or thrice a week

Version Description by
20200616 Scorecard in 3 languages ENG, FRA, PRT Andry
20200618 Homogenous font color in the scorecard Andry
20200622 -Replace 5.2 MVE with COVID-19 Andry
-Correction with the PRT version
-Added details at the bottom of the evaluation
- HC Facility name and Date
- The summary graphic bars

20200625 Corrections: removed MVE, fix codes French version Landry

component 5 (PPE). Replaced Waste Sorting by Waste
Segregation
20200629 Define printing pagination Andry
20200706 Adjusted the header of the section 12 Andry
20200823 Change the "75% < Score" to "Score>75%" Andry
20201008 Included the Proposed Corrective Actions when the user Andry
selects No
20201012 Change the protection equipment to COVID Ebeth
- gloves, masks, apons/gowns, eye protection
- gants, masques, tabliers et lunettes de protection
- luvas, máscaras, aventais e óculos de protecção